A network meta-analysis of the efficacy and safety of second-line treatment regimens for HER2-positive advanced gastric cancer
- VernacularTitle:HER2阳性晚期胃癌二线治疗方案有效性和安全性的网状Meta分析
- Author:
Na LI
1
;
Su LI
2
;
Kemeng LI
3
;
Danxue HUANG
2
Author Information
1. Dept. of Gastroenterology，Cancer Hospital of Dalian University of Technology/Liaoning Cancer Hospital & Institute，Shenyang 110042，China
2. Dept. of Pharmacy，Cancer Hospital of Dalian University of Technology/Liaoning Cancer Hospital & Institute，Shenyang 110042，China
3. School of Life Science and Biopharmaceutics，Shenyang Pharmaceutical University，Shenyang 110016，China
- Publication Type:Journal Article
- Keywords:
advanced gastric cancer;
HER2-positive;
second-line treatment;
anbenitamab;
trastuzumab deruxtecan;
Network Meta-analysis
- From:
China Pharmacy
2026;37(18):2449-2455
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE To evaluate the efficacy and safety of second-line treatment regimens for human epidermal growth factor receptor 2 （HER2）-positive advanced gastric cancer.METHODS Phase Ⅲ randomized controlled trials（RCTs） about second-line treatment regimens for HER2-positive advanced gastric cancer patients were retrieved from PubMed， CNKI， and other Chinese and English databases. The search period spanned from the inception to April 1， 2026. After screening the literature， extracting data， and assessing the quality of the included studies， a network meta-analysis was conducted using R 4.3.2 software. Descriptive comparisons of characteristic adverse events （AEs） for each intervention were performed， followed by sensitivity analyses using different effect models to evaluate the robustness of the results.RESULTS A total of 5 RCTs involving 6 intervention regimens were included. Regarding efficacy， compared with trastuzumab emtansine， chemotherapy alone， and lapatinib+paclitaxel， anbenitamab+chemotherapy significantly prolonged patients’ median overall survival （OS） and median progression-free survival （PFS） （ P ＜0.05）. Compared with ramucirumab+paclitaxel and trastuzumab emtansine， trastuzumab deruxtecan also significantly prolonged patients’ median OS and median PFS （ P ＜0.05）. The top two treatment regimens in terms of surface under the cumulative ranking curve （SUCRA） were both anbenitamab+chemotherapy and trastuzumab deruxtecan. In terms of safety， the SUCRA for the incidence of adverse events （AEs） of any grade （41.6%-57.1%） was generally similar across treatments. The SUCRA for the incidence of grade≥3 AEs and serious AEs was lowest for trastuzumab emtansine （19.3%） and chemotherapy alone （25.9%）， respectively. The SUCRA for treatment-related mortality was lowest for anbenitamab+chemotherapy （3.7%）， while the SUCRA for treatment discontinuation due to AEs was lowest for trastuzumab deruxtecan （4.3%）； for both， the SUCRA was highest for lapatinib+paclitaxel （78.3% and 85.6%， respectively）. Regarding characteristic AEs， the incidence of interstitial lung disease/pneumonitis was highest in the trastuzumab deruxtecan group （13.93%）， the incidence of diarrhea was highest in the lapatinib+paclitaxel group （77.10%）， and hypertension was primarily observed in the ramucirumab+paclitaxel group （23.85%）. The results of the sensitivity analysis were consistent with those of the main analysis.CONCLUSIONS For second-line treatment regimens of patients with HER2-positive advanced gastric cancer， both anbenitamab+chemotherapy and trastuzumab deruxtecan demonstrate a trend toward superior OS and PFS benefits； in terms of safety， the incidence rates of AEs of any grade are similar across the intervention groups， but the characteristic profiles of AEs differ significantly among the regimens， requiring close clinical monitoring and comprehensive management throughout treatment.
