HER2 amplification level is not a prognostic factor for HER2-positive breast cancer with trastuzumab-based adjuvant treatment: a systematic review and meta-analysis

// Qian-Qian Xu 1 , Bo Pan 1 , Chang-Jun Wang 1 , Yi-Dong Zhou 1 , Feng Mao 1 , Yan Lin 1 , Jing-Hong Guan 1 , Song-Jie Shen 1 , Xiao-Hui Zhang 1 , Ya-Li Xu 1 , Ying Zhong 1 , Xue-Jing Wang 1 , Yan-Na Zhang 1 , Qiang Sun 1 1 Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, P. R. China Correspondence to: Qiang Sun, email: sunqiangpumc@126.com Keywords: HER2-positive breast cancer, HER2 amplification, prognosis, trastuzumab-based treatment, adjuvant setting Received: June 21, 2016      Accepted: August 17, 2016      Published: August 23, 2016 ABSTRACT Background: Trastuzumab-based therapy is a standard, targeted treatment for HER2-positive breast cancer in the adjuvant setting. However, patients do not benefit equally from it and the association between HER2 amplification level and patients’ survival remains controversial. A systematic review and meta-analysis was conducted by incorporating all available evidence to evaluate the association between disease free survival (DFS) and HER2 amplification level. Results: Three cohort studies involving 1360 HER2-positive breast cancer patients stratified by HER2 amplification magnitude were eligible for meta-analysis. The combined HRs for DFS were 1.05 (95% CI: 0.80−1.36, p = 0.74) and 0.97 (95% CI: 0.73−1.29, p = 0.83) for HER2 gene copy number (GCN) and HER2/CEP 17 ratio. No evidence of heterogeneity or public bias was found. Methods: Databases including PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL), were searched for eligible literature. HER2 amplification level was evaluated by fluorescence in situ hybridization (FISH) in terms of gene copy number (GCN) and HER2/CEP17 ratio. Hazard ratios (HRs) for DFS with 95% confidence interval (CI) according to the amplification level of HER2 were extracted. The outcomes were synthesized based on a fixed-effects model. Conclusions: HER2 amplification level is not a prognostic factor for HER2-positive breast cancer with trastuzumab-based targeted therapy in the clinical adjuvant setting.