Universität zu Köln

Brandao, Mariana ORCID: 0000-0002-1653-3544, Maurer, Christian, Ziegelmann, Patricia Klarmann, Ponde, Noam F., Ferreira, Arlindo ORCID: 0000-0002-1567-9322, Martel, Samuel, Piccart, Martine, de Azambuja, Evandro ORCID: 0000-0001-9501-4509, Debiasi, Marcio and Lambertini, Matteo ORCID: 0000-0003-1797-5296 (2020). Endocrine therapy-based treatments in hormone receptor-positive/HER2-negative advanced breast cancer: systematic review and network meta-analysis. ESMO Open, 5 (4). LONDON: BMJ PUBLISHING GROUP. ISSN 2059-7029

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Abstract

Background Several endocrine therapy (ET)-based treatments are available for patients with advanced breast cancer. We assessed the efficacy of different ET-based treatments in patients with hormone receptor-positive/HER2-negative advanced breast cancer with endocrine-sensitive or endocrine-resistant disease. Methods We searched Medline and Cochrane Central Register of Controlled Trials up to 15 October 2019 and abstracts from major conferences from 2016 to October 2019. We included phase II/III randomised trials, comparing >= 2 ET-based treatments. Progression-free survival (PFS) and overall survival (OS) were analysed by network meta-analyses using MTC Bayesian models based on both fixed-effect and random-effect models; relative treatment effects were measured as HRs and 95% credibility intervals (CrI). All statistical tests were two-sided. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed and this systematic review is registered in the PROSPERO database. Results 55 publications reporting on 32 trials (n=12 293 patients) were included. Regarding PFS in the endocrine sensitive setting (n=5200; 12 trials), the combination of cyclin-dependent kinases (CDK)4/6-inhibitors (CDK4/6i)+fulvestrant 500 mg (F500) was likely the most effective treatment (surface under the cumulative ranking curve (SUCRA)=97.3%), followed by CDK4/6i+aromatase inhibitor +/- goserelin; there was no significant difference between them (HR 0.82; 95% CrI 0.54-1.25). Regarding OS (n=2157; five trials), the most effective treatment was probably CDK4/6i+F500 (SUCRA=97.3%); comparing CDK4/6i+F500 versus F500 held a HR of 0.77 (95% CrI 0.63-0.95). Regarding PFS in the endocrine-resistant setting (n=6635; 20 trials), CDK4/6i+F500 was likely the most effective treatment (SUCRA=95.7%), followed by capivasertib+F500, without significant difference between them (HR 0.91; 95% CrI 0.60-1.36). For OS (n=4377; 11 trials), the most effective treatments were capivasertib+F500 (SUCRA=84.7%) and CDK4/6i+F500 (SUCRA=69.9%). Comparing CDK4/6i+F500 versus F500 held a HR of 0.77 (95% CrI 0.67-0.89). Conclusions CDK4/6i+F500 is likely the best treatment option in both endocrine-sensitive and endocrine-resistant diseases for PFS, and in endocrine-sensitive patients for OS. Concerning OS in endocrine-resistant patients, capivasertib+F500 and CDK4/6i+F500 are likely the best treatments. PROSPERO registration number CRD42018104628.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Brandao, Mariana UNSPECIFIED orcid.org/0000-0002-1653-3544 UNSPECIFIED Maurer, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Ziegelmann, Patricia Klarmann UNSPECIFIED UNSPECIFIED UNSPECIFIED Ponde, Noam F. UNSPECIFIED UNSPECIFIED UNSPECIFIED Ferreira, Arlindo UNSPECIFIED orcid.org/0000-0002-1567-9322 UNSPECIFIED Martel, Samuel UNSPECIFIED UNSPECIFIED UNSPECIFIED Piccart, Martine UNSPECIFIED UNSPECIFIED UNSPECIFIED de Azambuja, Evandro UNSPECIFIED orcid.org/0000-0001-9501-4509 UNSPECIFIED Debiasi, Marcio UNSPECIFIED UNSPECIFIED UNSPECIFIED Lambertini, Matteo UNSPECIFIED orcid.org/0000-0003-1797-5296 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-327267
DOI:	10.1136/esmoopen-2020-000842
Journal or Publication Title:	ESMO Open
Volume:	5
Number:	4
Date:	2020
Publisher:	BMJ PUBLISHING GROUP
Place of Publication:	LONDON
ISSN:	2059-7029
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language EVEROLIMUS PLUS EXEMESTANE; GROWTH-FACTOR RECEPTOR; PHASE-II TRIAL; PROGRESSION-FREE SURVIVAL; FULVESTRANT 500 MG; DOUBLE-BLIND; POSTMENOPAUSAL WOMEN; AROMATASE INHIBITORS; 1ST-LINE TREATMENT; AMERICAN SOCIETY Multiple languages Oncology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/32726