Strength of recommendations: A1
Indication: Metastatic breast cancer overexpressing HER-2
Characterization of the technology: Trastuzumab is a humanized monoclonal antibody derived from recombinant DNA, which binds to the receptor extracellular domain of human epidermal growth factor, HER2. This antibody blocks the natural ligand and infra-regulates the receptor. Its use alone or in combination with chemotherapy provides deceleration in the progression of metastatic breast cancer HER-2 positive.
Question: The use of trastuzumab is effective and safe in the treatment of metastatic breast cancer in women overexpressing HER-2? Search and analysis of scientific evidence: Databases were searched The Cochrane Library, Centre for Reviews and Dissemination (CRD), Tripdatabase, Medline (via Pubmed) and LILACS, aiming to find systematic reviews (SR) of clinical trials that compared trastuzumab to other options therapies for the treatment of metastatic breast cancer. We selected only those studies published in English, Portuguese or Spanish.
Summary of results of selected studies: 9 SR were selected. In general, the chemotherapy combined with trastuzumab have better outcomes than chemotherapy alone, the overall survival, disease-free survival and time to disease progression. In the SR, which evaluates the combination of trastuzumab with anthracycline there is increased risk of cardiac dysfunction.
Recommendations: The use of trastuzumab in combination with paclitaxel or docetaxel as first-line therapy for women with metastatic breast cancer overexpressing HER-2 is recommended.
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