Objective: To explore the difference in efficacy and safety of pyrotinib or lapatinib combined with chemotherapy in human epidermal growth factor receptor-2 (HER-2) positive breast cancer patients who failed the first-line trastuzumab-containing treatment.
Methods: The present retrospective study included 164 HER-2 positive breast cancer patients admitted to our hospital. Among them, 68 cases received pyrotinib combined with chemotherapy after the failure of trastuzumab first-line treatment (pyrotinib group), and the other 96 cases received lapatinib combined chemotherapy (lapatinib group). The end of the follow-up time was set as June 1, 2020. The primary endpoint was progression free survival (PFS), and the secondary endpoints included best objective response rate (ORR) and safety.
Results: Till the end of the follow-up, the best ORR (60.3% vs. 34.4%) in the pyrotinib group was significantly higher than that in the lapatinib group, and the median PFS (9.0 months vs. 6.2 months) was also largely prolonged (P<0.01). In addition, the median PFS of the patients with brain metastases in the pyrotinib group was 6.5 months, and was much longer that in the lapatinib group which wereth 3.5 months in length (P<0.05). Multivariate COX regression analysis showed that pyrotinib combined with chemotherapy (HR=0.653, P<0.05) was associated with longer PFS of patients, while the lapatinib group had a higher proportion of vomiting and hand foot syndrome than the pyrotinib group (P<0.05).
Conclusion: After the failure of first-line trastuzumab-containing treatment, combination of pyrotinib with chemotherapy has more significant short-term efficacy in HER-2 positive breast cancer patients than lapatinib combined with chemotherapy, especially in patients with brain metastasis.
Keywords: Pyrotinib; breast cancer; human epidermal growth factor receptor-2; safety; trastuzumab.
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