Evaluating the optimal treatment regimens given before and after surgery in improving survival outcomes in patients with HER2-positive breast cancer.

This study evaluated the optimal treatment regimens given before and after surgery in terms of improving the survival outcomes in patients with human epidermal growth factor receptor 2-positive (HER2+) breast cancer (BC). The data showed that chemotherapy plus trastuzumab (Herceptin) and pertuzumab (Perjeta) was the best treatment regimen for improving the survival rates of these patients.

BC is classified into different subtypes depending on the presence or absence of certain receptors (proteins found on the surface of the cancer cells). HER2 is a protein that can be found on cancer cells that promotes their growth. This subtype of BC is called HER2-positive (HER2+) BC. Patients with this subtype of BC commonly receive targeted therapy such as trastuzumab and pertuzumab.

Neoadjuvant therapy is often given before surgery to shrink the cancer so that it can be completely removed by surgery. Adjuvant therapy is often used after surgery to destroy any remaining cancer cells and to prevent cancer recurrence.

Lapatinib (Tykerb) is a targeted therapy that blocks HER2 and stops BC growth. Trastuzumab and pertuzumab lock onto HER2 and blocks its actions. Previous studies have shown that adding trastuzumab to chemotherapy significantly improves the survival of patients with early-stage, HER2-positive BC but is also associated with heart-related side effects. The optimal adjuvant or neoadjuvant regimens in terms of improving survival outcomes in patients with HER2-positive remain unclear.

This study analyzed 15 other studies involving a total of 33,226 women with HER2+ BC. 11 treatment regimens were analyzed.

Chemotherapy plus trastuzumab and lapatinib had the highest probability (81%) of being the best treatment regimen in terms of improving the survival rates without any signs or symptoms of cancer followed by chemotherapy plus trastuzumab and pertuzumab (79%).

Chemotherapy plus trastuzumab with lapatinib had the highest probability (88%) of being the best treatment regimen in terms of improving the overall survival rates followed by chemotherapy plus trastuzumab with pertuzumab (74%).

Regarding adjuvant therapy only, chemotherapy plus trastuzumab with sequential neratinib (Nerlynx) had the highest probability (80%) of being the best treatment regimen in terms of improving the survival rates without any signs or symptoms of cancer followed by chemotherapy plus trastuzumab with pertuzumab (76%).

The dual-target therapy that combines trastuzumab and pertuzumab showed the highest risk of being associated with heart-related side effects (92%).

This study concluded that chemotherapy plus trastuzumab and pertuzumab was the best treatment regimen for improving the survival rates of patients with HER2+ BC. However, the authors suggested that heart-related side effects of this dual-target therapy should be taken care of while deciding on treatment options.

The number of studies analyzed was very small. The definitions of outcomes, the dose, and duration of therapies, the baseline chemotherapy regimens, and the follow-up time in the studies analyzed were different.