Incidence and risk of central nervous system metastases as site of first recurrence in patients with HER2-positive breast cancer treated with adjuvant trastuzumab

被引:113
作者
Olson, E. M. [1 ,2 ]
Abdel-Rasoul, M. [1 ,2 ]
Maly, J. [1 ,2 ]
Wu, C. S. [1 ,2 ]
Lin, N. U. [3 ]
Shapiro, C. L. [1 ,2 ]
机构
[1] Ohio State Univ, Ctr Comprehens Canc, Arthur G James Canc Hosp, Div Med Oncol,Dept Internal Med, Columbus, OH 43210 USA
[2] Ohio State Univ, Richard J Solove Res Inst, Columbus, OH 43210 USA
[3] Dana Farber Canc Inst, Div Womens Canc, Boston, MA 02115 USA
关键词
breast cancer; central nervous system; hER2; meta-analysis; metastases; trastuzumab; BRAIN METASTASES; CONCURRENT TRASTUZUMAB; NEOADJUVANT TREATMENT; CHEMOTHERAPY; METAANALYSIS; PACLITAXEL; EPIRUBICIN; THERAPY; TRIAL;
D O I
10.1093/annonc/mdt036
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background: Central nervous system (CNS) disease as the site of first relapse after exposure to adjuvant trastuzumab has been reported. We carried out comprehensive meta-analysis to determine the risk of CNS metastases as the first site of recurrence in patients with HER2-positive breast cancer who received adjuvant trastuzumab. Methods: Eligible studies include randomized trials of adjuvant trastuzumab administered for 1 year to patients with HER2-positive breast cancer who reported CNS metastases as first site of disease recurrence. Statistical analyses were conducted to calculate the incidence, relative risk (RR), and 95% confidence intervals (CIs) using fixed-effects inverse variance and random-effects models. Results: A total of 9020 patients were included. The incidence of CNS metastases as first site of disease recurrence in HER2-positive patients receiving adjuvant trastuzumab was 2.56% (95% CI 2.07% to 3.01%) compared with 1.94% (95% Cl 1.54% to 2.38%) in HER2-positive patients who did not receive adjuvant trastuzumab. The RR of the CNS as first site of relapse in trastuzumab-treated patients was 1.35 (95% CI 1.02-1.78, P = 0.038) compared with control arms without trastuzumab therapy. The ratio of CNS metastases to total number of recurrence events was 16.94% (95% Cl 10.85% to 24.07%) and 8.33% (95% Cl 6.49% to 10.86%) for the trastuzumab-treated and control groups, respectively. No statistically significant differences were found based on trastuzumab schedule or median follow-up time. No evidence of publication bias was observed. Conclusions: Adjuvant trastuzumab is associated with a significant increased risk of CNS metastases as the site of first recurrence in HER2-positive breast cancer patients.
引用
收藏
页码:1526 / 1533
页数:8
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