Effectiveness of combined targeted and hormonal therapies for post-menopausal women with hormone receptor-positive and HER2-negative advanced breast cancer : a systematic review and meta-analysis of RCTs

Abstract

OBJECTIVE : we aim to synthesize available evidence on the effectiveness of hormonal plus targeted therapies for post-menopausal women with hormone receptor-positive and HER2-negative advanced breast cancer. DATA SOURCES AND METHODS : We searched the following databases: Medline, PubMed, Cochrane Library, CINAHL, Web of Science, Scopus, and African Journal. Only studies that investigated the effectiveness of hormonal therapy combined with targeted therapy for HR+/HER2- advanced breast cancer treatment were included. The outcomes were progression-free survival (PFS), overall survival (OS) and objective response rate (ORR). A random-effect meta-analysis model was employed. Statistical analysis was performed using Comprehensive Meta-analysis version 3. RESULTS : 24 studies were included in the meta-analysis with an overall sample size of 7635. Median PFS, OS and ORR were found to be significantly increased in the combination group compared to hormonal monotherapy [SMD = 6.072 (95% CI = 3.785–8.360), p < 0.001], [SMD = 1.614 (95% CI = 0.139–3.089), p = 0.032] and [OR = 1.584 (CI 1.134–2.213), p = 0.007] respectively. Subgroup analysis showed a significant difference in PFS and ORR between patients who received “hormonal therapy + CDK4/6 inhibitors” vs hormonal therapy only [SMD = 6.015 (CI 3.069–8.960), p < 0.001], (OR = 1.828 (CI 1.030–3.243), p = 0.039] respectively. CONCUSION : Compared with hormonal monotherapy, targeted plus hormonal therapy significantly improves PFS, OS and ORR in postmenopausal women with HR+/HER2- advanced breast cancer.