Efficacy of neoadjuvant chemotherapy combined with bevacizumab versus neoadjuvant chemotherapy alone for Her2-negative breast cancer: a meta-analysis of randomized controlled clinical trials.
- Author:
Rui HAN
1
;
Guanying WANG
1
;
Yujiao ZHANG
1
;
Xinhan ZHAO
2
Author Information
1. Department of Oncology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.
2. Department of Oncology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China. zhaoxinhanprof@163.com.
- Publication Type:Journal Article
- MeSH:
Antineoplastic Combined Chemotherapy Protocols;
therapeutic use;
toxicity;
Bevacizumab;
adverse effects;
therapeutic use;
toxicity;
Breast Neoplasms;
chemistry;
drug therapy;
Female;
Humans;
Neoadjuvant Therapy;
adverse effects;
methods;
Prospective Studies;
Receptor, ErbB-2;
analysis;
Triple Negative Breast Neoplasms;
drug therapy
- From:
Journal of Zhejiang University. Medical sciences
2016;45(4):379-386
- CountryChina
- Language:Chinese
-
Abstract:
To evaluate the efficacy and safety of neoadjuvant chemotherapy combined with bevacizumab versus neoadjuvant chemotherapy alone for Her2-negative breast cancer.We searched PubMed, the Cochrane Library, Web of Science, CNKI, Wanfang Database and the abstracts of major international conferences in recent 5 years to identify prospective randomized controlled clinical trials that met the inclusion and exclusion criteria. Study selection and analyses were undertaken according to the Cochrane Handbook. Meta-analysis was performed using RevMan 5.3 software.Six trials were identified with 4440 eligible patients. The results of this meta-analysis showed that the rate of pathological complete response (pCR) was higher in Her-2 negative breast cancer patients receiving bevacizumab combined with neoadjuvant chemotherapy than that in patients with neoadjuvant chemotherapy alone (24.7% vs 20.1%,=1.23, 95%:1.10-1.37,<0.01). In addition, the pCR rate rose up when bevacizumab was added to neoadjuvant chemotherapy both in hormone receptor-positive patients (13.1% vs 10.2%,=1.28, 95%:1.04-1.58,<0.05) and in hormone receptor-negative patients (46.3% vs 37.1%,=1.25, 95%:1.12-1.39,<0.01). Statistical differences were observed in the rate of relevant adverse events such as hypertention (3.2% vs 0.6%,=5.292, 95%:2.933-9.549,<0.01) and mucositis (10.5% vs 2.0%,=5.340, 95%:3.743-7.617,<0.01) between the combination group and the chemotherapy alone group. Differences in other toxicities such as febrile neutropenia, infection, surgical complications, neutropenia and hand-foot syndrome were also found to be statistically significant between the combination group and the chemotherapy alone group (all<0.05), while such difference was not found in the occurrence of peripheral neuropathy (>0.05).The addition of bevacizumab to neoadjuvant chemotherapy in Her2-negative breast cancer can significantly improve pathological complete response, but may bring more grade 3 and 4 toxicities.More neoadjuvant trials need to be done to define subgroups of Her2-negative breast cancer that would have clinically significant long-term benefit from bevacizumab treatment.
