Abstract
PurposeTo compare palbociclib + letrozole and palbociclib + fulvestrant with chemotherapy agents in postmenopausal women with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2−) advanced/metastatic breast cancer (ABC/MBC) who had no prior systemic treatment for advanced disease (first line) or whose disease progressed after prior endocrine therapy or chemotherapy (second line).MethodsA systematic search identified randomized controlled trials (RCTs) published from January 2000 to January 2016 that compared endocrine-based therapies, chemotherapy agents, and/or chemotherapy agents + biological therapies in the first- and second-line treatment of postmenopausal women with HR+/HER2− ABC/MBC. The main outcome of interest was progression-free survival (PFS)/time to progression (TTP). Bayesian network meta-analyses (NMAs) and pairwise meta-analyses were conducted. Heterogeneity and inconsistency were assessed.ResultsSixty RCTs met eligibility criteria and were stratified by line of therapy. In the first line, palbociclib + letrozole showed statistically significant improvements in PFS/TTP versus capecitabine [intermittent: HR 0.28 (95% CrI 0.11–0.72)] and mitoxantrone [HR 0.28 (0.13–0.61)], and trended toward improvements versus paclitaxel [HR 0.59 (0.19–1.96)], docetaxel [HR 0.51 (0.14–2.03)] and other monotherapy or combination agents (HRs ranging from 0.24 to 0.99). In the second line, palbociclib + fulvestrant showed statistically significant improvements in PFS/TTP versus capecitabine [intermittent: HR 0.28 (0.13–0.65)], mitoxantrone [HR 0.26 (0.12–0.53)], and pegylated liposomal doxorubicin [HR 0.19 (0.07–0.50)], and trended toward improvements versus paclitaxel [HR 0.48 (0.16–1.44)], docetaxel [HR 0.71 (0.24–2.13)] and other monotherapy or combination agents (HRs ranging from 0.23–0.89). NMA findings aligned with direct evidence and were robust to sensitivity analyses.ConclusionsPalbociclib + letrozole and palbociclib + fulvestrant demonstrate trends in incremental efficacy compared with chemotherapy agents for the first- and second-line treatment of HR +/HER2− ABC/MBC.
Highlights
Postmenopausal women with hormone receptor-positive (HR?), human epidermal growth factor receptor type 2-negative (HER2-) tumors represent the majority of patients with advanced/metastatic breast cancer (ABC/ MBC) [1,2,3]
Palbociclib ? letrozole and palbociclib ? fulvestrant demonstrate trends in incremental efficacy compared with chemotherapy agents for the first- and second-line treatment of hazard ratios (HRs) ?/HER2- ABC/MBC
We report the results of a systematic literature review (SLR) and network meta-analysis (NMA) that evaluates the efficacy of palbociclib ? letrozole and palbociclib ? fulvestrant versus chemotherapy agents in postmenopausal women with HR?/HER2- ABC/ MBC who had no prior systemic treatment for advanced disease or whose disease had progressed after prior endocrine therapy or chemotherapy
Summary
Postmenopausal women with hormone receptor-positive (HR?), human epidermal growth factor receptor type 2-negative (HER2-) tumors represent the majority of patients with advanced/metastatic breast cancer (ABC/ MBC) [1,2,3]. After receiving first-line endocrine therapy, many patients experience disease progression due to endocrine resistance and are offered chemotherapy as second-line therapy [2]. Palbociclib (IBRANCEÒ; Pfizer Inc, New York, NY, USA) is a new oral cyclin-dependent kinase 4/6 (CDK4/6) inhibitor approved by the United States (US) Food and Drug Administration (FDA) for HR?/HER2- ABC/MBC in combination with letrozole as initial endocrine-based therapy [5], or in combination with fulvestrant for patients whose disease had progressed following prior endocrine therapy [6]. Fulvestrant versus chemotherapy agents in postmenopausal women with HR?/HER2- ABC/ MBC who had no prior systemic treatment for advanced disease (first line) or whose disease had progressed after prior endocrine therapy or chemotherapy (second line) We report the results of a systematic literature review (SLR) and network meta-analysis (NMA) that evaluates the efficacy of palbociclib ? letrozole and palbociclib ? fulvestrant versus chemotherapy agents in postmenopausal women with HR?/HER2- ABC/ MBC who had no prior systemic treatment for advanced disease (first line) or whose disease had progressed after prior endocrine therapy or chemotherapy (second line)
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
