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The efficacy and safety of targeted therapy plus fulvestrant in postmenopausal women with hormone-receptor positive advanced breast cancer: A meta-analysis of randomized-control trials
- Source :
- PLoS ONE, Vol 13, Iss 9, p e0204202 (2018), PLoS ONE
- Publication Year :
- 2018
- Publisher :
- Public Library of Science (PLoS), 2018.
-
Abstract
- Objective To evaluate the efficacy and safety of targeted therapy plus fulvestrant for postmenopausal patients with hormone receptor-positive advanced breast cancer. Methods Pubmed, Embase and Web of Science databases were systematically searched on February 26, 2018. Eligible studies were screened according to selection criteria, and two reviewers independently extracted outcome data which included progression-free survival, overall survival, objective response rate, clinical benefit rate and toxicities. RevMan 5.3 and STATA 11.0 software were used to conduct meta-analysis. Results Thirteen articles including twelve randomized-control trials fulfilled selection criteria. There was no evidence regarding the existence of publication bias and high-risk bias of quality in the selected studies. In previously endocrine therapy-treated postmenopausal patients with hormone-receptor positive advanced breast cancer, the PFS (HR = 0.77, 95%CI: 0.66-0.91) and ORR (RR = 1.78, 95%CI: 1.35-2.34) of combination therapy group were significantly higher than that from fulvestrant monotherapy group. Besides, a statistically significant difference in PFS was found across the two arms in postmenopausal women with PIK3CA-mutant ctDNA tumor (HR = 0.52, 95% CI: 0.39-0.69). Moreover, the risk of adverse events (RR = 1.09, 95%CI: 1.05-1.13), CTCAE≥3 (RR = 1.97, 95%CI: 1.49-2.60) and discontinuation due to adverse events (RR = 4.91, 95%CI: 3.37-7.15) were also significantly different between two treatment groups. Sensitivity analysis showed PLOMA-3 trial was an important factor of heterogeneity. Discussion Even though the combination of targeted therapy plus fulvestrant improved PFS and increased ORR in advanced breast cancer patients, the toxicities of combination therapy were also higher than fulvestrant monotherapy. Further studies related to inhibitors targeting the specific signaling pathway or receptors are urgently needed, and more efforts concerning precision medicine of targeted therapy plus endocrine therapy should be taken to improve the clinical benefits.
- Subjects :
- Oncology
Receptor, ErbB-2
medicine.medical_treatment
Cancer Treatment
lcsh:Medicine
Toxicology
Pathology and Laboratory Medicine
Biochemistry
Targeted therapy
law.invention
Database and Informatics Methods
Mathematical and Statistical Techniques
0302 clinical medicine
Randomized controlled trial
law
Breast Tumors
Medicine and Health Sciences
Molecular Targeted Therapy
030212 general & internal medicine
Database Searching
lcsh:Science
Fulvestrant
Randomized Controlled Trials as Topic
Multidisciplinary
Endocrine Therapy
Combined Modality Therapy
Postmenopause
Treatment Outcome
Receptors, Estrogen
Research Design
030220 oncology & carcinogenesis
Physical Sciences
Female
Statistics (Mathematics)
Research Article
medicine.drug
medicine.medical_specialty
Antineoplastic Agents, Hormonal
Combination therapy
Clinical Research Design
Breast Neoplasms
Research and Analysis Methods
03 medical and health sciences
Breast cancer
Internal medicine
Breast Cancer
medicine
Humans
Statistical Methods
Adverse effect
Toxicity
business.industry
lcsh:R
Cancers and Neoplasms
Biology and Life Sciences
Cancer
Publication bias
medicine.disease
Survival Analysis
Hormones
lcsh:Q
Adverse Events
business
Mathematics
Meta-Analysis
Subjects
Details
- ISSN :
- 19326203
- Volume :
- 13
- Database :
- OpenAIRE
- Journal :
- PLOS ONE
- Accession number :
- edsair.doi.dedup.....a0910e1301e96eb86e9f7de24e3fd2e9