Background.
Randomized clinical trials (RCT) that evaluated the addition of lapatinib to trastuzumab plus neoadjuvant chemotherapy (NAC) in patients with HER2‐positive, operable breast cancer ...revealed a questionable improvement in pathologic complete response (pCR) rate. We performed a meta‐analysis of prospective RCTs that examined the effect of adding lapatinib to trastuzumab and NAC on pCR rate.
Methods.
PubMed databases and s from the proceedings of the American Society of Clinical Oncology and the San Antonio Breast Cancer Symposium were searched for RCTs that compared lapatinib plus trastuzumab and NAC with trastuzumab in combination with NAC and that included pCR as the primary outcome. Our main objective was to estimate the effect of adding lapatinib to trastuzumab plus NAC on pCR rate, defined as no residual invasive cancer in breast and axillary lymph nodes.
Results.
In total, 1,017 patients with early stage breast cancer from 5 trials were included. Four trials examined the addition of lapatinib to trastuzumab plus NAC; this resulted in statistically significant improvement in pCR, defined as no residual carcinoma in breast and lymph nodes. The pCR rate was 55.76% and 38.36% in the lapatinib plus trastuzumab and the trastuzumab plus NAC arms, respectively (odds ratio OR: 1.94; 95% confidence interval CI: 1.44–2.60). In three trials, the rates of pCR, defined as no residual invasive carcinoma in breast only, for the lapatinib plus trastuzumab and trastuzumab‐alone groups were 55.01% and 40.70%, respectively, also resulting in significant improvement (OR: 1.78; 95% CI: 1.27–2.50).
Conclusion.
The addition of lapatinib to trastuzumab in combination with neoadjuvant chemotherapy significantly improves pCR rates in patients with HER2‐positive breast cancer.
This meta‐analysis reports that the addition of lapatinib to trastuzumab and neoadjuvant chemotherapy improves pathologic complete response (pCR) rates in patients with HER2‐positive breast cancer, regardless of the pCR definition or hormone receptor status.
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