ArticleTranslational cancer research2026
Efficacy and safety of antibody-drug conjugates for HR+/HER2-low advanced breast cancer: a systematic review with Bayesian network meta-analysis and real-world study.
Article in Translational cancer research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Antibody-drug conjugates (ADCs), such as trastuzumab deruxtecan (T-DXd) and sacituzumab govitecan (SG) offer new and potent options for curing for curing hormone receptor-positive (HR+)/human epidermal growth factor receptor 2 (HER2)-low advanced breast cancer; however, comparisons in terms of their relative effectiveness and safety concerns are lacking. We conducted a network meta-analysis (NMA) and a real-world study (RWS) to comprehensively evaluate these agents and validate clinical trial findings in routine practices. Methods: A Bayesian NMA of randomized controlled trials (RCTs) published up to November 2024 comparing ADCs with treatment of the physician's choice (TPC) was performed. Progression-free survival (PFS), overall survival (OS), tumor response rates, and grade ≥3 treatment-related adverse events (TRAEs) were obtained. Additionally, real-world survival data from our center [2013-2024] regarding T-DXd and SG usage were analyzed and compared with RCT results. Results: Three RCTs involving 1,643 patients were included. Compared with TPC, ADCs significantly improved PFS [hazard ratio (HR) =0.51, 95% credible interval (CI): 0.36-0.72] and OS (HR =0.75, 95% CI: 0.65-0.86). Probability rankings favored T-DXd for PFS and SG for OS. ADCs significantly increased objective response rate (ORR) and clinical benefit rate (CBR) (P<0.05). Although ADCs showed marginally higher grade ≥3 adverse events (AEs), the lowest rate among ADCs was shown by T-DXd, while SG had the highest. In the RWS (n=22), T-DXd demonstrated a significantly longer average PFS compared to SG (5 Conclusions: ADCs significantly improved the clinical outcomes of patients with HR+/HER2 low expression advanced breast cancer. Compared with other ADC drugs, T-DXd showed relatively better treatment characteristics, better PFS benefit, and relatively low incidence of serious AEs (SAEs). Combined with RCTs and real-world data, T-DXd has potential advantages in this population.
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