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Multiple Bayesian network meta-analyses to establish therapeutic algorithms for metastatic triple negative breast cancer
- Source :
- Scientia, CANCER TREATMENT REVIEWS, Cancer treatment reviews
- Publication Year :
- 2022
- Publisher :
- ELSEVIER SCI LTD, 2022.
-
Abstract
- Immunotherapy; PARP inhibitors; Pembrolizumab Immunoteràpia; Inhibidors de PARP; Pembrolizumab Inmunoterapia; Inhibidores de PARP; Pembrolizumab Metastatic triple-negative breast cancer (mTNBC) is a poor prognostic disease with limited treatments and uncertain therapeutic algorithms. We performed a systematic review and multiple Bayesian network meta-analyses according to treatment line to establish an optimal therapeutic sequencing strategy for this lethal disease. We included 125 first-line trials (37,812 patients) and 33 s/further-lines trials (11,321 patients). The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall response rates (ORR), overall survival (OS) and safety, for first and further lines, separately. We also estimated separate treatment rankings for the first and subsequent lines according to each endpoint, based on (surface under the cumulative ranking curve) SUCRA values. No first-line treatment was associated with superior PFS and OS than paclitaxel ± bevacizumab. Platinum-based polychemotherapies were generally superior in terms of ORR, at the cost of higher toxicity.. PARP-inhibitors in germline-BRCA1/2-mutant patients, and immunotherapy + chemotherapy in PD-L1-positive mTNBC, performed similar to paclitaxel ± bevacizumab. In PD-L1-positive mTNBC, pembrolizumab + chemotherapy was better than atezolizumab + nab-paclitaxel in terms of OS according to SUCRA values. In second/further-lines, sacituzumab govitecan outperformed all other treatments on all endpoints, followed by PARP-inhibitors in germline-BRCA1/2-mutant tumors. Trastuzumab deruxtecan in HER2-low mTNBC performed similarly and was the best advanced-line treatment in terms of PFS and OS after sacituzumab govitecan, according to SUCRA values. Moreover, comparisons with sacituzumab govitecan, talazoparib and olaparib were not statistically significant. The most effective alternatives or candidates for subsequent lines were represented by nab-paclitaxel (in ORR), capecitabine (in PFS) and eribulin (in PFS and OS).
- Subjects :
- PD-L1
Paclitaxel
Network Meta-Analysis
BRCA
Immunoteràpia
Medicaments antineoplàstics - Ús terapèutic
Otros calificadores::Otros calificadores::/farmacoterapia [Otros calificadores]
Algorismes
Triple Negative Breast Neoplasms
Immunotheraphy
Poly(ADP-ribose) Polymerase Inhibitors
Other subheadings::Other subheadings::/drug therapy [Other subheadings]
B7-H1 Antigen
Sacituzumab govitecan
Càncer de mama
Metastasis
Breast cancer
Metàstasi
Therapeutics::Therapeutics::Drug Therapy::Antineoplastic Protocols::Therapeutics::Drug Therapy::Antineoplastic Combined Chemotherapy Protocols [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT]
Antineoplastic Combined Chemotherapy Protocols
Medicine and Health Sciences
Humans
Radiology, Nuclear Medicine and imaging
Trastuzumab deruxtecan
Triple negative breast cancer
PARP inhibitors
Bayesian network meta-analysi
terapéutica::terapéutica::farmacoterapia::protocolos antineoplásicos::terapéutica::farmacoterapia::protocolos de quimioterapia antineoplásica combinada [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS]
Enzyme inhibitors
Bayes Theorem
General Medicine
neoplasias::neoplasias por localización::neoplasias de la mama::neoplasias de mama triple negativos [ENFERMEDADES]
Bayesian statistical decision
Bevacizumab
PARP inhibitor
Estadística bayesiana
Inhibidors enzimàtics
Oncology
Settore SECS-S/01 - STATISTICA
Mama - Càncer - Tractament
Neoplasms::Neoplasms by Site::Breast Neoplasms::Triple Negative Breast Neoplasms [DISEASES]
Bayesian network meta-analysis
Therapeutic algorithm
Human medicine
HER2-low
Immunotherapy
Pembrolizumab
Algorithms
Subjects
Details
- Language :
- English
- ISSN :
- 03057372 and 15321967
- Database :
- OpenAIRE
- Journal :
- Scientia, CANCER TREATMENT REVIEWS, Cancer treatment reviews
- Accession number :
- edsair.doi.dedup.....a5b4eda5fa74b8ce1e6191f822cb50ac