Summary

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• This summary is based on the review of 43 systematic review(s)/meta-analysis(es). ^[1-41]
• Trastuzumab-Based Regimens: Trastuzumab combined with epirubicin significantly increased the pathological complete response (pCR) rate compared to non-anthracycline regimens (odds ratio (OR) = 1.48, 95% confidence interval (CI), 1.04 to 2.12). Additionally, the addition of pertuzumab to trastuzumab further enhanced pCR rates (OR = 2.10, 95% CI, 1.56 to 2.83).
• Pyrotinib combined with trastuzumab and chemotherapy achieved a pooled pCR rate of 57% (95% CI: 47-68%). There was no significant difference in pCR between anthracycline-free and anthracycline-containing regimens (OR = 0.95; 95% CI: 0.61-1.48).
• In terms of survival outcomes, 12 months of trastuzumab significantly improved disease-free survival (DFS) and overall survival (OS) compared to shorter durations, and dual anti-HER2 therapy (trastuzumab + pertuzumab) significantly improved OS (hazard ratio (HR) = 0.77, 95% CI: 0.59-0.99) and progression-free survival (PFS) (HR = 0.74, 95% CI: 0.63-0.86).
• For advanced/metastatic disease, trastuzumab combined with tyrosine kinase inhibitors (TKIs) showed better progression-free survival (PFS) and overall response rate (objective response rate (ORR) (>/= 3 adverse events (AEs))) compared to dual-targeted therapy. Monochemotherapy with dual-target therapy remained optimal for advanced breast cancer patients.
• The combination of trastuzumab and epirubicin did not significantly increase cardiotoxicity compared to nonconcurrent regimens (RR = 1.18, 95% CI = 0.68-2.05), while dual anti-HER2 therapy (trastuzumab + pertuzumab) was associated with an increased risk of clinical heart failure (RR = 1.97, 95% CI: 1.05-3.70).
• Pyrotinib combined with trastuzumab and chemotherapy resulted in high rates of treatment-related adverse events (TRAEs), with diarrhea occurring in 98% of patients, anemia in 71%, vomiting in 69%, and leucopenia in 66%.
• Anthracycline-containing regimens showed a higher incidence of left ventricular ejection fraction decreases compared to anthracycline-free regimens (OR = 0.50; 95% CI: 0.35-0.71), highlighting specific cardiotoxic risks with these treatments.
• In hormone receptor (HR)-negative patients, trastuzumab and pertuzumab therapy demonstrated higher efficacy, while concurrent trastuzumab and epirubicin regimens in HR-positive patients increased cardiotoxicity and showed less significant pCR rates. Dual-target therapy was highly recommended for node-positive patients, while lapatinib with trastuzumab was preferred for node-negative patients.