Lapatinib and Capecitabine in the Treatment of Her2-Positive Breast Cancer with Brain Metastases

Dubiański, Roman; Brewczyńska, Elżbieta; Lemańska, I.; Szombara, Ewa; Nowecki, Zbigniew

doi:10.1093/annonc/mdu329.47

Cited by 2 publications

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“…A total number of 16 studies, including 693 patients combined, which investigated LC have been included in the meta-analysis; 2 randomized phase 2 studies [ 61 , 69 ], 2 single arm phase 2 studies [ 63 , 66 ], 1 expansion cohort of a single arm phase 2 study [ 55 ], 3 expanded access program studies [ 58 , 59 , 64 ], 6 retrospective studies [ 60 , 62 , 65 , 67 , 68 , 70 ] and 2 posthoc analyses of open label phase 3 trials ( Table 3 ) [ 34 , 45 ]. This demonstrated a pooled ORR of 28% (95% CI 21–35%; I 2 62%).…”

Section: Resultsmentioning

confidence: 99%

Systemic Therapy for Patients with HER2-Positive Breast Cancer and Brain Metastases: A Systematic Review and Meta-Analysis

Werter

Remmelzwaal

Burchell

et al. 2022

Cancers

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Aim: Patients with HER2-positive (HER2+) metastatic breast cancer (mBC) develop brain metastases (BM) in up to 30% of cases. Treatment of patients with BM can consist of local treatment (surgery and/or radiotherapy) and/or systemic treatment. We undertook a systematic review and meta-analysis to determine the effect of different systemic therapies in patients with HER2+ mBC and BM. Methods: A systematic search was performed in the databases PubMed, Embase.com, Clarivate Analytics/Web of Science Core Collection and the Wiley/Cochrane Library. Eligible articles included prospective or retrospective studies reporting on the effect of systemic therapy on objective response rate (ORR) and/or median progression free survival (mPFS) in patients with HER2+ mBC and BM. The timeframe within the databases was from inception to 19 January 2022. Fixed-effects meta-analyses were used. Quality appraisal was performed using the ROBINS-I tool. Results: Fifty-one studies were included, involving 3118 patients. Most studies, which contained the largest patient numbers, but also often carried a moderate-serious risk of bias, investigated lapatinib and capecitabine (LC), trastuzumab-emtansine (T-DM1) or pyrotinib. The best quality data and/or highest ORR were described with tucatinib (combined with trastuzumab and capecitabine, TTC) and trastuzumab-deruxtecan (T-DXd). TTC demonstrated an ORR of 47.3% in patients with asymptomatic and/or active BM. T-DXd achieved a pooled ORR of 64% (95% CI 43–85%, I2 0%) in a heavily pretreated population with asymptomatic BM (3 studies, n = 96). Conclusions: Though our meta-analysis should be interpreted with caution due to the heterogeneity of included studies and a related serious risk of bias, this review provides a comprehensive overview of all currently available systemic treatment options. T-Dxd and TTC that appear to constitute the most effective systemic therapy in patients with HER2+ mBC and BM, while pyrotinib might be an option in Asian patients.

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