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Comparative efficacy of palbociclib, ribociclib and abemaciclib for ER+ metastatic breast cancer: an adjusted indirect analysis of randomized controlled trials
- Publication Year :
- 2019
-
Abstract
- Several trials have demonstrated the benefit of anti-CDK4/6 inhibitors plus endocrine therapy in estrogen receptor-positive (ER+) advanced breast cancer (BC), in first or subsequent lines of therapy. However, due to the lack of direct/indirect comparisons, there are no data demonstrating the superiority of one drug over the other. We compared the effectiveness of palbociclib, ribociclib, and abemaciclib in advanced ER + BC via an indirect adjusted analysis. We performed electronic searches in the PubMed, EMBASE, and Cochrane databases for prospective phase 3 randomized trials evaluating anti-CDK4/6 inhibitors plus endocrine agents. We compared the results with an adjusted indirect analysis of randomized-controlled trials. Outcomes of interest were progression-free survival (PFS), overall response rate (ORR) and G3–4 toxicities occurring in ≥ 5% of patients. Six trials and six treatment arms including a total of 3743 participants, were included. For PFS and ORR analysis, the three agents were similar in both first- and second-line studies. All G3–4 toxicities were similar, with reduced risk of diarrhea for palbociclib versus abemaciclib (relative risk [RR] 0.13, 95% CI 0.02–0.92; P = 0.04) and of QTc prolongation for palbociclib versus ribociclib (RR 0.02, 95% CI 0–0.83; P = 0.03). Despite different inclusion criteria and length of follow-up, similar features were noticed among second-line studies with the exception of increased risk of anemia G3–4 and diarrhea G3–4 for abemaciclib. Based on PFS and ORR results of this indirect meta-analysis, palbociclib, ribociclib, and abemaciclib are equally effective in either first- or second-line therapy for advanced ER + BC. They, however, ported different toxicity profiles.
- Subjects :
- 0301 basic medicine
Oncology
medicine.medical_specialty
Cancer Research
Pyridines
Aminopyridines
Breast Neoplasms
Palbociclib
Piperazines
law.invention
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
Breast cancer
CDK-4/6 inhibitors
Randomized controlled trial
law
Internal medicine
medicine
Humans
Prospective Studies
Abemaciclib
Randomized Controlled Trials as Topic
business.industry
Cancer
medicine.disease
Survival Analysis
Metastatic breast cancer
Meta-analysis
Treatment Outcome
030104 developmental biology
Clinical Trials, Phase III as Topic
Receptors, Estrogen
chemistry
Purines
030220 oncology & carcinogenesis
Relative risk
Benzimidazoles
Female
business
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....7152397824d26a1562f0f39d91a50fe3