A Meta-analysis Of Neoadjuvant Trastuzumab Or Lapatinib Or Their Combination In Breast Cancer

Objective:To evaluate the efficacy and safety of the neoadjuvant trastuzumab or lapatinib or their combination in HER2-positive breast cancer. Methods:We searched PubMed, MEDLINE, The Cochrane Library, Web of science, CNKI, Wanfang datebase and the abstracts of major international conferences in recent 5 years to identify randomized controlled trials (RCTs) that met the inclusion and exclusion criteria. Study selection and analyses were undertaken according to the Cochrane Handbook. Meta-analysis was performed using RevMan 5.0 software. Results:Seven trials were identified with 2227 eligible patients. The results of meta-analyses showed that pCR was significantly lower in the group with lapatinib than in the group with trastuzumab [RR=0.80,95%CI (0.70-0.92),P=0.002]. Nevertheless, pCR was much higher in the group with combination than in the group with trastuzumab or lapatinib[RR=1.36,95%CU (1.19-1.56), P<0.00001 and RR=1.64,95%CI(1.28-2.11), P=0.0001]. In terms of the grade III-IV toxicities, diarrhea[RR=6.74,95%CI (4.20-10.82), P<0.00001], dermatologic toxicity[RR=6.42, 95%CI (3.20-12.88), P<0.00001] and hepatic toxicity[RR=1.78,95%CI (1.05-3.02), P=0.03] were statistically more frequent in lapatinib arm than in trastuzumab arm. The diarrhea[RR=12.20,95%CI(6.36-23.41), P<0.00001] and dermatologic toxicity[RR=3.76, 95%CI(1.81-7.83), P=0.0004] were statistically more frequent in combination arm than in trastuzumab arm. However, no differences were observed among patients receiving their combination or lapatinib,on the contrary, the grade III-IV congestive heart-failure was statistically more infrequent in patients receiving the combination arm[RR=0.21, 95%CI(0.05-0.82), P=0.02]). Conclusion:These data dedicate trastuzumab is much superior to lapatinib, and there has a superiority of a dual-HER2 inhibition of trastuzumab and lapatinib for the treatment of HER2-positive breast cancer in the neoadjuvant setting.