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AIM: To evaluate efficacy and safety of lapatinib or trastuzumab alone or both plus chemotherapy for the treatment of breast cancer patients with positive HER-2 expression. METHODS: Cochrane Central Register of Controlled Trials, PubMed, MEDLINE, OVID, Embase, Chinese Biomedical Literature Database, and China Academic Journals Database were searched from 1994 through December 2017 using the keywords "breast cancer", "preoperative", "neo-adjuvant", "lapatinib", "pertuzumab", "Herceptin", and "trastuzumab". RESULTS: Meta-analysis found that pathological complete response (PCR; risk ratio [RR]=0.82, 95% CI: 0.72-0.93) and tall PCR (tPCR; RR=0.77, 95% CI: 0.67-0.88) of chemotherapy plus lapatinib were significantly less effective or safe compared to that of chemotherapy plus trastuzumab (P<0.05). PCR (RR=1.30, 95% CI: 1.15-1.47) and tPCR (RR=1.32, 95% CI: 1.16-1.50) of chemotherapy plus both lapatinib and trastuzumab were significantly superior to that of chemotherapy plus trastuzumab alone (P<0.05). However, there was no significant difference in breast reservation rate between chemotherapy plus lapatinib vs chemotherapy plus trastuzumab (RR=0.91, 95% CI: 0.72-1.16) or chemotherapy plus both lapatinib and trastuzumab (RR=1.11, 95% CI: 0.73-1.68, P>0.05). Incidence of diarrhea, hepatic toxicity, and skin rash in the groups of chemotherapy plus lapatinib or chemotherapy plus both lapatinib and trastuzumab was significantly higher than that in chemotherapy plus trastuzumab (P<0.05). CONCLUSION: Efficacy of lapatinib was less than that of trastuzumab, but incidence of adverse effect of lapatinib was higher than that of trastuzumab. Combination of chemotherapy plus both lapatinib and trastuzumab could significantly increase PCR and tPCR in breast cancer patients, but rate of breast conservation, event-free survival, and overall survival was not significantly improved. Incidence of diarrhea, hepatic toxicity, and skin rash was significantly increased in the groups using lapatinib.
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OBJECTIVE: To systematically evaluate safety and efficacy of temozolomide plus radiotherapy in the treatment of brain metastasis. METHODS: Literature was searched in the following databases: Cochrane Controlled Trials Register (CENTRAL), PubMed (1994-2015.10), CBM (1978-2015.10), CNKI (1994-2015.10), VIP (1994-2015.10), and WANFANG (1994-2015.10). Randomized clinical trials (RCTs) of temozolomide plus radiotherapy in comparison with radiotherapy alone were included in this review and meta-analysis. The quality of included literatures was assessed by the international Cochrane collaboration method, and meta-analysis was performed using RevMan 5.0 software. RESULTS: Total 19 publications of RCTs were included, and there was no allocation concealment or blinding in any of them. Six of the 19 were multicenter RCTs. Overall response rate (ORR) was in favor of radiotherapy plus temozolomide (risk ratio [RR] = 1.35, 95% CI: 1.23-1.47). Subgroup analysis of non-small cell lung cancer (NSCLC) metastasis brain tumor also showed that ORR was in favor of radiotherapy plus temozolomide (RR = 1.38; 95% CI: 1.17-1.63). Progression-free survival (PFS) or overall survival rate, however, was not significantly different between the 2 treatment groups. In addition, incidence of side effect was significantly higher in the group of radiotherapy plus temozolomide than that of radiotherapy alone (HR = 2.03, 95% CI: 1.56-2.64). CONCLUSION: Addition of temozolomide to radiotherapy could increase ORR in brain metastatic tumors. However, it did not significantly improve PFS or OS in the patients with brain metastases but increased risk of drug-related toxicity.