KEY TAKEAWAYS
- The study aimed to examine the efficacy and toxicity of epirubicin and trastuzumab concurrent regimens in pts with HER2+ EBC.
- The key endpoint of the study was to evaluate the pCR.
- Researchers concluded that epirubicin and trastuzumab enhanced pCR rates without notable cardiotoxicity, advising caution for HR-positive tumors.
The concurrent use of epirubicin and trastuzumab has not been completely explored due to cardiotoxicity-related issues.
Ming-Han Yang and the team aimed to assess the efficacy and the cardiotoxicity corresponding to epirubicin and trastuzumab concurrent regimens in patients (pts) with human epidermal growth factor receptor 2 (HER2)+ early breast cancer (EBC).
Researchers conducted a systematic search for relevant literature in the NCBI/PubMed, the Cochrane database, and international conference abstracts for phase 2 or 3 randomized controlled trials performed from January 1, 2000, to February 28, 2021.
The analysis was primarily focused on the concurrent regimens in pts with HER2+ EBC.
The linear meta-regression analysis was performed to draw a comparative outline of the risk of cardiotoxicity and the odds of the pathological complete response (pCR) rate and to corroborate the effects of multiple covariates.
About 7 neoadjuvant trials involving the concurrent use of epirubicin and trastuzumab with 1,797 pts were included in the analysis. The median cumulative dose of epirubicin used was 300 mg/m², with a total of 96 reported adverse cardiac events. The concurrent regimens did not result in a significant increase in cardiotoxicity compared to nonconcurrent regimens (risk ratio (RR)= 1.18, 95% CI= 0.68-2.05).
Compared with nonconcurrent or non-anthracycline-containing regimens, concurrent regimens were associated with a significant increase in the pCR rate (OR = 1.48, 95% CI= 1.04-2.12). The linear fixed-effects meta-regression analysis indicated that in trials including more pts with HER2+ EBC, the RR of cardiotoxicity significantly increased with concurrent regimens, and the pCR rate became less significant.
The study concluded that the combination of epirubicin and trastuzumab (with a low dose of epirubicin ) statistically enhanced the pCR rate without a noticeable incline in cardiotoxicity. It is recommended to further explore the concurrent regimens for HR-negative, HER2+ tumors for improved pCR rates, with a precaution advised for HR+ tumors due to potential cardiotoxicity.
This study was funded by the National Science and Technology Council (NSTC 111-2314-B-002-042) and the Ministry of Health and Welfare (MOHW 112-TDU-B-211-144002).
Source: https://pubmed.ncbi.nlm.nih.gov/39046067/
Yang MH, Huang CS, Chang DY, et al. (2024). “Concurrent epirubicin and trastuzumab use increases complete pathological response rate without additional cardiotoxicity in patients with human epidermal growth factor receptor 2-positive early breast cancer: A meta-regression analysis.” Cancer Med. 2024 Jul;13(14):e70005. doi: 10.1002/cam4.70005. PMID: 39046067.
