Introduction
Methods
Data sources and searches
Study selection
Data extraction
Data analyses
Results
First-line metastatic BC
Clinical trial | Reference | Year | Target population | T1 | T2 | Primary endpoint of efficacy | Patients on T1, n
| Patients on T2, n
| OS T1 | OS T2 | HR (95 % CI), p value | PFS T1 | PFS T2 | HR (95 % CI), p value |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Chemotherapy ± trastuzumab or lapatinib
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Slamon 2001 | Slamon et al. [1] | 2001 | Women with progressive mBC that overexpressed HER2 who had not previously received chemotherapy for metastatic disease | Chemotherapy once every 3 weeks for six cycles + trastuzumab loading dose 4 mg/kg on day 1, then 2 mg/kg every week until PD | Chemotherapy alone once every 3 weeks for six cycles | TTP | 234 | 235 | 25.1 | 20.3 | 0.80 (0.64–1.00), p = 0.046 | 6.9 | 4.5 | 0.58 (0.47–0.70), p < 0.001 |
JO17360 | Inoue et al. [16] | 2009 | Women with HER2-positive mBC, measurable lesion(s) fulfilling RECIST criteria, ECOG-PS 0–1, and LVEF > 50 % | Trastuzumab loading dose 4 mg/kg then 2 mg/kg every week + docetaxel 60 mg/m2 every 3 weeks | Trastuzumab loading dose 4 mg/kg then 2 mg/kg every week until PD followed by trastuzumab loading dose 4 mg/kg then 2 mg/kg every week + docetaxel 60 mg/m2 every 3 weeks | PFS; OS | 53 | 54 | NA | NA | NA | 14.6 | 3.7 | 4.24 (2.48, 7.24), p < 0.01 |
EGF104535 | Guan et al. [15] | 2013 | Women with newly diagnosed HER2-positive mBC (no prior treatment for metastatic disease was allowed, with the exception of hormonal treatment for patients with hormone receptor–positive disease; prior trastuzumab and/or taxane as neoadjuvant or adjuvant therapy were permitted provided therapy was completed 12 months before study entry) | Lapatinib (1500 mg/d) + paclitaxel (80 mg/m2 once per week for 3 weeks every 4 weeks) | Placebo once per day + paclitaxel (80 mg/m2 once per week for 3 weeks every 4 weeks) | OS | 222 | 221 | 27.8 | 20.5 | 0.74 (0.58, 0.94), p = 0.0124 | 9.7 | 6.5 | 0.52 (0.42, 0.64), p = 0.001 |
Chemotherapy + lapatinib versus chemotherapy + trastuzumab
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MA.31 | Gelmon et al. [31] | 2015 | Women with HER2-positive mBC, ECOG-PS 0–2, no prior therapy with cytotoxics or biologics for recurrent or advanced disease, baseline LVEF ≥ 50 %, measurable or nonmeasurable disease defined by RECIST (v1.0) criteria, and no major end-organ disease | Lapatinib (1250 mg/d) + taxane (paclitaxel 80 mg/m2 once per week on days 1, 8, and 15 of a 28-day schedule or docetaxel 75 mg/m2 once every 3 weeks) for 24 weeks followed by lapatinib (1,500 mg/d) until PD | Trastuzumab + taxane (once per week [4 mg/kg bolus followed by 2 mg/kg maintenance] + once per week paclitaxel; or once every 3 week [8 mg/kg bolus followed by 6 mg/kg maintenance] + docetaxel once every 3 weeks) for 24 weeks followed by trastuzumab (6 mg/kg once every 3 weeks) until PD | PFS | 326 | 326 | NA | NA | 1.28 (0.95, 1.72), p = 0.11 | 9.0 | 11.3 | 1.37 (1.13, 1.65), p < 0.001 |
Hormone therapy ± trastuzumab or lapatinib
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TAnDEM | Kaufman et al. [18] | 2009 | Postmenopausal women with HER2-positive and hormone receptor–positive mBC; LVEF > 50 %; ECOG-PS 0–1; and measurable or evaluable disease; prior chemotherapy for mBC or adjuvant chemotherapy within 6 months was not permitted | Anastrozole 1 mg/day + trastuzumab loading dose 4 mg/kg on day 1, then 2 mg/kg every week until PD | Anastrozole 1 mg/day until PD | PFS | 103 | 104 | 28.5 | 23.9 |
p = 0.325 | 4.8 | 2.4 | 0.63 (0.47, 0.84), p = 0.0016 |
EGF30008 | 2009 | Postmenopausal women with histologically confirmed stage IIIB/IIIC or IV ER-positive and/or PgR–positive invasive breast cancer; LVEF within the range of normal; ECOG-PS 0–1. No prior therapy for advanced or metastatic disease was allowed | Lapatinib 1500 mg and letrozole 2.5 mg daily until PD | Letrozole 2.5 mg daily with matching lapatinib placebo pill until PD | PFS | 111 | 108 | 33.3 | 32.3 | 0.74 (0.5, 1.1), p = 0.113 | 8.2 | 3 | 0.71 (0.53, 0.96), p = 0.019 | |
Chemotherapy A + trastuzumab versus chemotherapy B + trastuzumab
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Robert 2006 | Robert et al. [19] | 2006 | Women (≥18 years old) with pathologically confirmed, uni- or bidimensionally measurable, HER-2-positive mBC; ECOG-PS 0–2. Patients could not have received prior chemotherapy for mBC | Carboplatin AUC = 6 + paclitaxel 175 mg/m2 every 3 weeks for six cycles trastuzumab 4 mg/kg loading dose, then 2 mg/kg weekly until PD | Paclitaxel 175 mg/m2 every 3 weeks for six cycles + trastuzumab 4 mg/kg loading dose, then 2 mg/kg weekly until PD | ORR | 98 | 98 | 35.7 | 32.2 | 0.9 (0.88, 0.92), p = 0.76 | 10.7 | 7.1 | 0.66 (0.59, 0.73), p = 0.03 |
HERNATA Study | Andersson et al. [12] | 2010 | Women (18 to 75 years old) with HER2-positive mBC or LABC; ECOG-PS ≤ 2; normal LVEF. Prior chemotherapy and HER2-targeted treatment was not allowed for treatment of metastatic or locally advanced disease | Vinorelbine 30 or 35 mg/m2 on days 1 and 8 every 3 weeks until PD + trastuzumab 8 mg/kg loading dose, then 6 mg/kg every 3 weeks until PD | Docetaxel 100 mg/m2 every 3 weeks until PD + trastuzumab 8 mg/kg loading dose, then 6 mg/kg every 3 weeks until PD | TTP | 141 | 143 | 38.8 | 35.7 | 1.01 (0.71, 1.42), p = 0.98 | 15.3 | 12.4 | 0.94 (0.71, 1.25), p = 0.67 |
BCIRG 007 Study | Valero et al. [22] | 2010 | Women (18 to 75 years old) with HER2-amplified mBC, either measurable lesions (RECIST criteria) or nonmeasurable disease including at least two radiologically evident lytic bone lesions, and a Karnofsky performance status ≥60 %. Patients were not eligible if they had received prior platinum salt therapy, chemotherapy, or trastuzumab for mBC | Carboplatin AUC = 6 every 3 weeks for eight cycles + docetaxel 75 mg/m2 weekly every 3 weeks for eight cycles + trastuzumab 4 mg/kg loading dose, then 2 mg/kg on days 1,8, and 15 every 3 weeks for eight cycles, then 6 mg/kg every 3 weeks until PD | Docetaxel 100 mg/m2 on every 3 weeks for eight cycles + trastuzumab 4 mg/kg loading dose, then 2 mg/kg on days 1,8, and 15 every 3 weeks for eight cycles, then 6 mg/kg every 3 weeks until PD | TTP | 132 | 131 | 37.4 | 37.1 |
p = 0.99 | 10.4 | 11.1 | 0.914 (0.694, 1.203), p = 0.57 |
NCT00294996 | Baselga et al. [14] | 2014 | Women with HER2-overexpressing mBC and no prior chemotherapy for metastatic disease | NPLD (50 mg/m2 every 3 weeks for six cycles) + trastuzumab (4 mg/kg loading dose followed by 2 mg/kg weekly) + paclitaxel (80 mg/m2 weekly) | Trastuzumab (4 mg/kg loading dose followed by 2 mg/kg weekly) + paclitaxel (80 mg/m2 weekly) | PFS | 181 | 182 | 33.6 | 28.9 | 0.79 (0.61, 1.03), p = 0.083 | 16.1 | 14.5 | 0.84 (0.65, 1.08), p = 0.174 |
Chemotherapy + trastuzumab and pertuzumab
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CLEOPATRA study | 2013 | Women (≥18 years old) with HER2-positive mBC (measurable disease or nonmeasurable disease); LEVF ≥ 50 %; ECOG-PS 0–1. Previous chemotherapy or biological treatment for metastatic disease was not allowed | Pertuzumab 840 mg loading dose, then 420 mg every 3 weeks until PD + trastuzumab 8 mg/kg loading dose, then 6 mg/kg every 3 weeks until PD + docetaxel 75 mg/m2 every 3 weeks for six cycles | Placebo 840 mg loading dose, then 420 mg every 3 weeks until PD + trastuzumab 8 mg/kg loading dose, then 6 mg/kg every 3 weeks until PD + docetaxel 75 mg/m2 every 3 weeks for six cycles | PFS | 402 | 406 | 56.5 | 40.8 | 0.68 (0.56, 0.84), p < 0.001 | 18.7 | 12.4 | 0.68 (0.58, 0.80), p = 0.001 | |
Everolimus in trastuzumab-resistant patients
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BOLERO-1 | Hurwitz et al. [32] | 2015 | Women (≥18 years old) with locally assessed HER2-positive, locally recurrent invasive breast cancer unamenable to resection with curative intent or metastatic disease, with ECOG-PS 0–1, with measurable disease as per RECIST or bone lesions in the absence of measurable disease; no previous systemic therapy for advanced disease was allowed | Everolimus (10 mg/day) + trastuzumab (4 mg/kg loading dose on day 1 with subsequent weekly doses of 2 mg/kg of each 4-week cycle) + paclitaxel (80 mg/m2 on days 1, 8, and 15 of each 4-week cycle) | Placebo + trastuzumab (4 mg/kg loading dose on day 1 with subsequent weekly doses of 2 mg/kg of each 4-week cycle) + paclitaxel (80 mg/m2 on days 1, 8, and 15 of each 4-week cycle) | PFSa
| 480 | 239 | NA | NA | NA | 14.95 | 14.49 | 0.89 (0.73, 1.08), p = 0.1166 |
Chemotherapy ± trastuzumab or lapatinib
Chemotherapy + lapatinib versus chemotherapy + trastuzumab
Hormone therapy ± trastuzumab or lapatinib
Chemotherapy A + trastuzumab versus chemotherapy B + trastuzumab
Chemotherapy + trastuzumab and pertuzumab
Everolimus in trastuzumab-resistant patients
Second-line metastatic BC and beyond
Clinical trial | Reference | Year | Target population | T1 | T2 | Primary endpoint of efficacy | Patients on T1, n
| Patients on T2, n
| OS T1 | OS T2 | HR (95 % CI), p value | PFS T1 | PFS T2 | HR (95 % CI), p value |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Chemotherapy ± trastuzumab or lapatinib
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Geyer 2006 | 2006 | Women with progressive, HER2-positive, locally advanced or metastatic breast cancer who had previously been treated with a minimum of an anthracycline, a taxane and trastuzumab | Lapatinib 1250 mg daily + capecitabine at a dose of 2000 mg/m2 in two divided doses on days 1 through 14 of a 21-day cycle | Capecitabine 2500 mg/m2 in two divided doses on days 1 through 14 of a 21-day cycle | TTP | 198 | 201 | 15.6 | 15.3 | 0.78 (0.55, 1.12) p = 0.177 | 8.4 | 4.1 | 0.47 (0.33, 0.67), p < 0.001 | |
A German Breast Group 26/Breast International Group 03–05 study | 2009 | Women with pathologically confirmed, HER-2–positive, locally advanced or metastatic breast cancer | Capecitabine 2500 mg/m2 (1250 mg/m2 twice daily) on days 1 through 14 followed by 1 week of rest | Capecitabine 2500 mg/m2 (1250 mg/m2 twice daily) on days 1 through 14 followed by 1 week of rest + trastuzumab 6 mg/kg body weight as a 30-minute infusion every 3 weeks until PD | TTP | 78 | 78 | 20.6 | 24.9 | 0.76 (0.48, 1.22) p = 0.257 | 5.6 | 8.2 | 0.69 (0.48, 0.97), p = 0.034 | |
Chemotherapy + trastuzumab or chemotherapy + lapatinib
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CEREBELa
| Pivot et al. [28] | 2015 | Women with HER2-positive mBC and without baseline CNS metastases. Patients were required to have received prior anthracycline and/or taxanes for (neo)adjuvant or metastatic disease. Prior trastuzumab was allowed but not required | Trastuzumab infusion of 6 mg/kg every 3 weeks (with possibly a loading dose of 8 mg/kg on day 1) and capecitabine 2500 mg/m2 per day on days 1 through 14, every 21 days | Lapatinib 1250 mg once daily and capecitabine 2000 mg/m2 per day on days 1 through 14, every 21 days | Incidence of CNS metastases as first site of relapse | 269 | 271 | 27.3 | 22.7 | 1.34 (0.95, 1.64), p = 0.095 | 8.1 | 6.6 | 1.30 (1.04, 1.64), p = 0.021 |
Lapatinib + trastuzumab
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EGF104900 study | 2012 | Women with ErbB2-positive mBC who experienced progression on prior trastuzumab-containing regimens | Lapatinib 1000 mg daily in combination with intravenous trastuzumab 2 mg/kg weekly (after the initial 4 mg/kg loading dose) | Lapatinib 1500 mg daily | PFS | 148 | 148 | 12.04 | 9.1 | 0.75 (0.53, 1.07) p = 0.106 | 2.8 | 1.9 | 0.73 (0.57, 0.93), p = 0.008 | |
Trastuzumab emtansine (T-DM1)
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EMILIA | Verma et al. [4] | 2012 | HER2-positive advanced breast cancer previously treated with trastuzumab and a taxane | T-DM1 3.6 mg/kg every 3 weeks until PD | Lapatinib 1250 mg/day + capecitabine 1000 mg/m2 twice a day on days 1–14 for 3 weeks until PD | PFS, OS | 495 | 496 | 30.9 | 25.1 | 0.68 (0.55, 0.85) p < 0.001 | 9.6 | 6.4 | 0.65 (0.55, 0.77), p < 0.001 |
TH3RESA | Krop et al. [27] | 2014 | Women (≥18 years, LVEF ≥ 50 %, ECOG-PS 0–2) with progressive HER2-positive advanced breast cancer who had received two or more HER2-directed regimens in the advanced setting, including trastuzumab and lapatinib, and previous taxane therapy in any setting | Trastuzumab emtansine (3.6 mg/kg intravenously every 21 days) | Physician’s choice | PFS, OS | 404 | 198 | NYR | 14.9 | 0.552 (0.369, 0.826), p = 0.0034 | 6.2 | 3.3 | 0.528 (0.422, 0.661), p < 0.0001 |
Everolimus in trastuzumab-resistant patients
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BOLERO-3 | André et al. [23] | 2014 | Women with HER2-positive, trastuzumab-resistant, advanced breast carcinoma who had previously received taxane therapy | Daily everolimus (5 mg/day) plus weekly trastuzumab (2 mg/kg) and vinorelbine (25 mg/m(2)) | Placebo plus trastuzumab plus vinorelbine, in 3-week cycles | PFS | 284 | 285 | NA | NA | NA | 7.00 | 5.78 | 0.78 (0.65, 0.95), p = 0.0067 |