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Purpose@#Combining targeted agents with adjuvant chemotherapy prolongs survival in human epidermal growth factor receptor 2 (HER2)-positive breast cancer patients, but also increases the risk of adverse effects. The updated results of 3 randomized controlled trials (RCTs) were reported in 2019. Given the lack of adequate head-to-head pairwise assessment for anti-HER2 agents, network meta-analysis facilitates obtaining more precise inference for evidence-based therapy. @*Methods@#RCTs comparing at least 2 anti-HER2 regimens in an adjuvant setting for HER2-positive early-stage breast cancer (EBC) were included. Hazard ratios for overall survival (OS) and disease free survival (DFS), with respective 95% confidence intervals were pooled for assessment of efficacy. A Bayesian statistical model was used, and odds ratios (ORs) for adverse events (AEs) were used to pool effect sizes. @*Results@#We demonstrated that 1-year trastuzumab plus chemotherapy had increased efficacy compared to shorter or longer treatment duration. The OR of cardiac events gradually increased from 6 months to 1 and 2-year trastuzumab arms, relative to chemotherapy only.Compared to trastuzumab plus chemotherapy, dual HER2-targeting therapies increased DFS, especially for hormone receptor negative patients. Dual anti-HER2 blockade regimens revealed an increased probability of gastrointestinal reactions. As a second agent, pertuzumab showed significantly higher DFS and OS. @*Conclusion@#We conclude that 1-year adjuvant trastuzumab should remain as the standard treatment for HER2-positive EBC patients, as it has greater efficacy and a manageable proportion of AEs. Clinical efficacy can be increased for hormone receptor-negative tumors by including a second HER2-targeted agent to the treatment regimen. For hormone receptorpositive cases with basal disease, it is acceptable to reduce the risk of cardiotoxicity by shortening the duration of trastuzumab.
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Dissociated optic nerve fiber layer (DONFL) appearance is consists of numerous arcuate dark striae within the posterior pole in the direction of the optic nerve fibers. And on the cross-sectional image, DONFL was correspond to inner retinal dimples. It mainly occurs after the internal limiting membrane (ILM) peeling due to the direct damage on the local retina and the broad tractional effect on the posterior retina during membrane peeling. DONFL appearance is considered to be a spontaneous and delayed morphologic change with a subclinical nature, and appears to have little effect on retinal function. In addition to avoiding the removal of ILM and reducing the area of ILM peeling, a novel technique for reposition of the fixed ILM flap with the assistance of perfluoro-n-octane and the temporal inverted ILM flap technique can also be used to prevent and reduce the occurrence of DONFL appearance. Further studies on its development, clinical features and clinical significance are still required.
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Purpose@#Combining targeted agents with adjuvant chemotherapy prolongs survival in human epidermal growth factor receptor 2 (HER2)-positive breast cancer patients, but also increases the risk of adverse effects. The updated results of 3 randomized controlled trials (RCTs) were reported in 2019. Given the lack of adequate head-to-head pairwise assessment for anti-HER2 agents, network meta-analysis facilitates obtaining more precise inference for evidence-based therapy. @*Methods@#RCTs comparing at least 2 anti-HER2 regimens in an adjuvant setting for HER2-positive early-stage breast cancer (EBC) were included. Hazard ratios for overall survival (OS) and disease free survival (DFS), with respective 95% confidence intervals were pooled for assessment of efficacy. A Bayesian statistical model was used, and odds ratios (ORs) for adverse events (AEs) were used to pool effect sizes. @*Results@#We demonstrated that 1-year trastuzumab plus chemotherapy had increased efficacy compared to shorter or longer treatment duration. The OR of cardiac events gradually increased from 6 months to 1 and 2-year trastuzumab arms, relative to chemotherapy only.Compared to trastuzumab plus chemotherapy, dual HER2-targeting therapies increased DFS, especially for hormone receptor negative patients. Dual anti-HER2 blockade regimens revealed an increased probability of gastrointestinal reactions. As a second agent, pertuzumab showed significantly higher DFS and OS. @*Conclusion@#We conclude that 1-year adjuvant trastuzumab should remain as the standard treatment for HER2-positive EBC patients, as it has greater efficacy and a manageable proportion of AEs. Clinical efficacy can be increased for hormone receptor-negative tumors by including a second HER2-targeted agent to the treatment regimen. For hormone receptorpositive cases with basal disease, it is acceptable to reduce the risk of cardiotoxicity by shortening the duration of trastuzumab.
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Subject(s)
Humans , Biomarkers , Breast Neoplasms , Breast , Drug Therapy , Neoadjuvant Therapy , Neoplasm, Residual , Pathology , Prognosis , United States Food and Drug AdministrationABSTRACT
Objective To observe the long-term clinical effect of pars plana vitrectomy combined with fovea-sparing internal limiting peeling in the treatment of macular foveoschisis in pathologic myopic. Methods A prospective case series study. Fifteen patients (15 eyes) with pathological myopic macular foveoschisis who received treatment in Eye Hospital of Wenzhou Medical University from December 2015 to December 2016 were enrolled. There were 4 males (4 eyes) and 11 females (11eyes), with an average age of 55.33±8.34 years. All patients underwent BCVA, diopter, spectral domain OCT and axial length measurement. The mean logMAR BCVA was 0.95±0.64. The mean central fovea thickness (CFT) was 576.00±185.32 μm. All patients underwent vitrectomy combined with fovea-sparing internal limiting peeling. After gas-liquid exchange, 12％ C3F8 was filled and followed up at 1, 3, 6 and 12 months after surgery. Follow-up time was more than 12 months. The structural changes of BCVA and macular area were observed.Results The foveal internal limiting membranes was successfully preserved in all eyes using the techinique. At the final follow-up, the CFT was 258.60±175.22 μm and the BCVA was 0.46±0.43, which were significantly improved compared with preoperative measurements (t=4.90, 5.20;P<0.001). Macular foveoschisis was resovled in 13 eyes. BCVA increased in 14 eyes. Internal limiting membranes proliferation and contraction occurred in 5 eyes and full-thickness macular hole occurred in 1 eye.Conclusions Pars plana vitrectomy with fovea-sparing internal limiting peeling is effective in the treatment of myopic macular retinoschisis. It can improve BCVA and CFT.
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Objective To observe the efficacy of pars plana vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade in the treatment of myopic macular retinoschisis (MF).Methods This is a retrospective case study.A total of 35 MF patients (36 eyes) were enrolled in this study.There were 5 males (5 eyes) and 30 females (31 eyes),with an average age of (60.13 ± 10.00) years.All patients were examined for best corrected visual acuity (BCVA),diopter,optical coherence tomography (OCT) and axial length.The patients were divided into a MF group (group A,10 eyes),MF with foveal detachment group (group B,12 eyes) and MF with lamellar macular hole group (group C,14 eyes) according to the OCT characteristics.There was no difference of age,gender,spherical equivalent refraction and axial length among 3 groups (F=0.020,0.624,0.009,0.195;P＞0.05).There were significant differences of the minimum resolution angle logarithm (logMAR) BCVA and central fovea thickness (CFT) (F=11.100,41.790;P＜ 0.05).All patients underwent pars plana vitrectomy with ILM peeling and gas tamponade.The follow-up was more than one year.The BCVA and macular structure at the final follow-up were analyzed.The efficacy between 3 forms of MF was compared.Results At the final follow-up,the BCVA was 0.40±0.44 and CFT was (213.35±97.58) μm,which were significantly improved compared with preoperative measurements (t=5.984,5.113;P＜0.001).MF was resolved in 33 eyes.In group A,B and C,the logMAR BCVA were 0.13 ± 0.10,0.73±0.33 and 0.38± 0.52,respectively;CFT was (222.40± 57.16),(212.50 ± 150.45),(206.67 ± 55.97) μm,respectively;MF was resolved in 10,11 and 12 eyes,respectively;complete ellipsoid was observe in 8,2 and 12 eyes.The logMAR BCVA (F=6.750,P=0.003) and the rate of complete ellipsoid (x2=18.590,P＜0.001) in group B was lower than group A and C,the differences were significant.There was no difference of CFT (F=0.068,P=0.935) and the rate of MF resolving (x2=1.558,P=0.459) among the three groups.One eye (1/14) in group C suffered from full layer macular hole.Conclusion Pars plana vitrectomy with ILM peeling and gas tamponade is effective in the treatment of myopic macular retinoschisis.The macular structures and BCVA are worst in eyes with foveal detachment.