Combination chemotherapy with trastuzumab in early-stage breast cancer: a meta-analysis and Bayesian decision analysis of different treatment regimens

Q. Liu

Department of Mathematical and Statistical Sciences, Marquette University, Milwaukee, WI, USA. edward.liu@marquette.edu

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• Oncology

OBJECTIVE: HER2-positive breast cancer is a high-risk malignant tumor, and trastuzumab is an effective targeted therapy drug, but its optimal duration remains uncertain. To compare the efficacy and cost-effectiveness of different durations (6 months, 9 months, 12 months, and 18 months) of trastuzumab combined with chemotherapy in patients with early breast cancer by meta-analysis and Bayesian decision analysis.

PATIENTS AND METHODS: Randomized controlled trials comparing the effectiveness of different durations of trastuzumab combination chemotherapy in early-stage breast cancer patients were collected by searching multiple databases. Data synthesis was performed using the R software, and a decision tree model was constructed to simulate the expected outcomes and anticipated costs associated with different treatment durations.

RESULTS: This study included 9 randomized controlled trials involving 11,328 early-stage breast cancer patients. The meta-analysis results demonstrated that, compared to the control group, trastuzumab combination chemotherapy at different durations significantly improved disease-free survival and overall survival in early-stage breast cancer patients. Among the various treatment durations, it was observed that 12 months of trastuzumab combination chemotherapy, in comparison to other durations, significantly reduced the risk of recurrence and mortality in early-stage breast cancer patients while maintaining a favorable cost-effectiveness ratio. Bayesian decision analysis also confirmed that 12 months of trastuzumab combination chemotherapy is the optimal treatment duration.

CONCLUSIONS: It is recommended to use 12 months of trastuzumab combination chemotherapy as the standard treatment for early-stage breast cancer patients.

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