eting neoadjuvant chemotherapy
once the Bean counters do the cost-effectiveness of saving lives access may increase in many countries!!! Hope Roche makes sure the costs of using 2 of their products needs to stay low enough for the cost effectiveness numbers to convince these people.
J Natl Cancer Inst. 2014 Sep 15;106(9). pii: dju203. Print 2014 Sep.
Comparative Effectiveness of Neoadjuvant Therapy for HER2-Positive Breast Cancer: A Network Meta-Analysis.
Nagayama A1, Hayashida T2, Jinno H1, Takahashi M1, Seki T1, Matsumoto A1, Murata T1, Ashrafian H1, Athanasiou T1, Okabayashi K2, Kitagawa Y1.
Author information
Abstract
BACKGROUND:
The growing number of antihuman epidermal growth factor receptor-2 (HER2) agents suggests the need for defining the optimal choice of neoadjuvant therapy for HER2-positive breast cancer. This study aims to assess the efficacy and safety of neoadjuvant therapy for HER2-positive breast cancer.
METHODS:
Randomized trials that compared different anti-HER2 regimens in the neoadjuvant setting were included. The odds ratio (OR) for pathological complete response (pCR), treatment completion, and safety was utilized for pooling effect sizes. Network meta-analysis using a Bayesian statistical model was performed to combine the direct and indirect evidence of neoadjuvant therapy for HER2-positive breast cancer. All statistical tests were two-sided.
RESULTS:
A database search identified 1047 articles, with 10 studies meeting the eligibility criteria. A total of 2247 patients in seven different treatment arms were assessed. Anti-HER2 agents evaluated included trastuzumab (tzmb), lapatinib (lpnb), and pertuzumab (pzmb). Network meta-analysis showed no statistically significant difference between dual targeting treatment arms; however, lpnb reduced treatment completion due to adverse events. Patients in dual targeting arms had statistically significantly more pCR than those in other treatment arms (chemotherapy [CT] + tzmb + pzmb vs CT + tzmb, OR = 2.29, 95% credibility interval = 1.02 to 5.02, P = .02). The surface under the cumulative ranking probability curve indicated that CT + tzmb + pzmb had the highest probability of being the best treatment arm in terms of pCR.
CONCLUSIONS:
This study indicates that combining two anti-HER2 agents with CT is the most effective treatment modality in the neoadjuvant setting for HER2-positive breast cancer.
© The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail:
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PMID: 25224562 [
metaanalysis--use to argue insurance co/govt coverage of dual her2 targe
Linear Mode
