Trastuzumab as An Adjuvant Therapy for Early Breast Cancer

• Published in: Journal of global oncology 2018-10, Vol.4 (Supplement 2), p.70-70s
• Main Authors: Lee, S.W., Kamaruzaman, H.F., Sabirin, J.
• Format: Article
• Language: English
• ISSN: 2378-9506; 2378-9506
• DOI: 10.1200/jgo.18.31500

Abstract only Background: In Malaysia, breast cancer is the most common cancer in females and also the first most common cancer among population regardless of gender. Trastuzumab is used for the treatment of early-stage breast cancer that is HER2 positive. Although this treatment has been routinely used, there are still controversial on the duration of the addition of trastuzumab to the chemotherapy regimen. Aim: To assess the safety and effectiveness of trastuzumab as an adjuvant in early breast cancer patients through a systematic review. Methods: Electronic databases were searched through the Ovid interface. The titles and abstracts were screened against the inclusion and exclusion criteria and then evaluated the selected full-text articles. Results: There was high level of evidence to suggest that the risk of congestive heart failure (CHF) was significantly higher in patients treated with trastuzumab compared with nontrastuzumab control group (RR 5.11; 90% CI: 3.00-8.72, P < 0.00001) in one Cochrane review, (RR 3.19; 95% CI: 2.03-5.02, P < 0.00001) in one systematic review and meta-analysis. Evidence also suggested that the risk was significantly higher with longer duration of treatment (> 6 months) RR 5.39; 90% CI: 3.56-8.17, P < 0.00001. The overall survival (OS) significantly favored trastuzumab-containing regimen over nontrastuzumab control group, (HR 0.66; 95% CI: 0.55-0.77, P < 0.00001). In terms of duration, subgroup analysis reported that the overall survival (OS) significantly favored trastuzumab-containing regimen over nontrastuzumab control group trials where trastuzumab was given longer (> 6 months), HR 0.67; 95% CI: 0.57-0.80, P < 0.00001. In the trials that gave trastuzumab and chemotherapy concurrently, HR significantly favored trastuzumab-containing regimens (HR 0.64; 95% CI: 0.57-0.80, P < 0.00001). The evidence from Cochrane systematic review suggests that disease-free survival (DFS) favored trastuzumab-containing regimen over the nontrastuzumab control group (HR 0.60; 95% CI: 0.50-0.71, P < 0.00001). In terms of duration of treatment, there was no significant difference in DFS when trastuzumab was used for less than six months or more than six months. The DFS significantly favored trastuzumab-containing regimen over nontrastuzumab control group when used either concurrently or sequentially. Limited evidence to suggest that two years duration of adjuvant trastuzumab was not more effective that one year of treatment. However, six month