Reviewer’s report
Title: 
Use of trastuzumab in treating breast cancer during pregnancy: a
systematic review and meta-analysis
Version: 
1 
Date: 
30 Mar 2021
Reviewer's report:
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BMWH-D-20-00401R1 - Review Observations and Recommendations
Recommendations highlighted in yellow
Abstract 
Please check the sample size as per your results inclusion and exclusion criteria
statements
ABS conclusion: P2,L42- Patients with gestational age smaller than below 30
years are less likely …..
Background:
General comments:
P3,L57- Even if the 
patients who use with trastuzumab therapy are advised to
pay attention to contraception, unexpected pregnancy also exists.
P3.L59 - pregnancy outcomes will may be caused by exposure to trastuzumab in
early pregnancy.
P3L67 - This work consulted reviewed previous literatures and collected a total
of 22 articles,…
P3, L69 - shed light on suitability (is it safety or suitability ???) of using
trastuzumab
Methods:
P3, L78 -Most data on trastuzumab use during pregnancy are were …
P4L85- The exclusive exclusion criteria disqualified
P4,L92- Figure 1- Check comment in the manuscript
Results:
P4,L97- After screening, 22 eligible articles were selected 22 articles that
satisfied the inclusion criteria for meta-analysis
P4, L99-101 - Out of 20 samples,
15 were hormone receptor -ve
5 were +ve
Total 20 cases is explained.
From where did the 2 unknown receptors come? (You have excluded 2 cases for
unreported gestation age in line 98 and have only 20 cases or patients). Please
check
P4L103- Your sample is only 20 and NOT 22 as you have excluded 2 cases in
line 98. Please check
[Results:
is the study sample Is it 20 or 23. 
Please make sure the eliminations due to exclusion criteria are not included in
the calculations. Please relook into your elimination statements.
Example:Section Results
P4, L97-105
Out of 20 samples,
15 were hormone receptor -ve
5 were +ve
Total 20 cases is explained.
From where did the 2 unknown receptors come?
You have excluded 2 cases for unreported gestation age in line 98 and have only
20 cases (patients). Please check]
P4L107- Please check the total dose of trastuzumab (2791mg)
P5L114- the average apgar score of the newborn is were 7,9 and the average
birth weight was 2310g. 39.13% (9/23)
P5L118- Apgar score of 7-10 is normally healthy as mentioned in line. Please
mention the outliers to justyfy the death.
P5L119- pregnancy and fetus related complications
P5L125 - chemotherapy.As shown in (Table 2).
P7L188 - increasing increase rapidly at 24 to 26 weeks
P8L202- Nevertheless, our research is very important for a may be useful for
patient's conceives while already undergoing trastuzumab therapy, and can
provide some reference for them to decide whether or not to continue their
pregnancy.
Reference: 
P10, L263- Please change ref 15, WALKER SP. Walker SP.
Figure 1: Restructure as Example provided
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
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from apparent manipulation?
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