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Rossi V, Berchialla P, Giannarelli D, Nisticò C, Ferretti G, Gasparro S, Russillo M, Catania G, Vigna L, Mancusi RL, Bria E, Montemurro F, Cognetti F, Fabi A. Should All Patients With HR-Positive HER2-Negative Metastatic Breast Cancer Receive CDK 4/6 Inhibitor As First-Line Based Therapy? A Network Meta-Analysis of Data from the PALOMA 2, MONALEESA 2, MONALEESA 7, MONARCH 3, FALCON, SWOG and FACT Trials. Cancers (Basel) 2019; 11:cancers11111661. [PMID: 31717791 PMCID: PMC6896062 DOI: 10.3390/cancers11111661] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 11/16/2022] Open
Abstract
Background: We aim to understand whether all patients with hormonal receptor (HR)-positive (+)/human epidermal growth factor receptor-2 (HER2)-negative (-) metastatic breast cancer (MBC) should receive cyclin D-dependent kinase (CDK) 4/6 inhibitor-based therapy as a first-line approach. METHODS A network meta-analysis (NMA) using the Bayesian hierarchical arm-based model, which provides the estimates for various effect sizes, were computed. RESULTS First-line treatment options in HR+/HER2- MBC, including CDK 4/6 inhibitors combined with aromatase inhibitors (AIs) or fulvestrant (F), showed a significantly longer progression-free survival (PFS) in comparison with AI monotherapy, with a total of 26% progression risk reduction. In the indirect comparison across the three classes of CDK 4/6 inhibitors and F endocrine-based therapies, the first strategy resulted in longer PFS, regardless of specific CDK 4/6 inhibitor (HR: 0.68; 95% CrI: 0.53-0.87 for palbociclib + AI, HR: 0.65; 95% CrI: 0.53-0.79 for ribociclib + AI, HR: 0.63; 95% CrI: 0.47-0.86 for abemaciclib + AI) and patient's characteristics. Longer PFS was also found in patients with bone-only and soft tissues limited disease treated with CDK 4/6 inhibitors. CONCLUSIONS CDK 4/6 inhibitors have similar efficacy when associated with an AI in the first-line treatment of HR+ MBC, and are superior to either F or AI monotherapy, regardless of any other patients or tumor characteristics.
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Affiliation(s)
- Valentina Rossi
- Breast Unit, S. Camillo-Forlanini Hospital of Rome, 00152 Rome, Italy; (V.R.); (L.V.)
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, University of Turin, 10124 Turin, Italy;
| | - Diana Giannarelli
- Department of Medical Statistics, IRCCS Regina Elena National Cancer Institute, 00128 Rome, Italy;
| | - Cecilia Nisticò
- Division of Medical Oncology1, IRCCS Regina Elena National Cancer Institute, 00128 Rome, Italy; (C.N.); (G.F.); (S.G.); (M.R.); (G.C.)
| | - Gianluigi Ferretti
- Division of Medical Oncology1, IRCCS Regina Elena National Cancer Institute, 00128 Rome, Italy; (C.N.); (G.F.); (S.G.); (M.R.); (G.C.)
| | - Simona Gasparro
- Division of Medical Oncology1, IRCCS Regina Elena National Cancer Institute, 00128 Rome, Italy; (C.N.); (G.F.); (S.G.); (M.R.); (G.C.)
| | - Michelangelo Russillo
- Division of Medical Oncology1, IRCCS Regina Elena National Cancer Institute, 00128 Rome, Italy; (C.N.); (G.F.); (S.G.); (M.R.); (G.C.)
| | - Giovanna Catania
- Division of Medical Oncology1, IRCCS Regina Elena National Cancer Institute, 00128 Rome, Italy; (C.N.); (G.F.); (S.G.); (M.R.); (G.C.)
| | - Leonardo Vigna
- Breast Unit, S. Camillo-Forlanini Hospital of Rome, 00152 Rome, Italy; (V.R.); (L.V.)
| | | | - Emilio Bria
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
- Department of Medical Oncology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Filippo Montemurro
- Direzione Day Hospital Oncologico Multidisciplinare, Istituto di Candiolo, FPO-IRCCS, 10060 Candiolo, Italy;
| | | | - Alessandra Fabi
- Division of Medical Oncology1, IRCCS Regina Elena National Cancer Institute, 00128 Rome, Italy; (C.N.); (G.F.); (S.G.); (M.R.); (G.C.)
- Correspondence: ; Tel.: +39-065266-5144
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Xu L, Yan N, Li Z, Luo L, Wu X, Liu Q, Xu Y, Cao Y. A comparison of fulvestrant plus a targeted agent with fulvestrant alone in hormone receptor-positive advanced breast cancer that progressed on prior endocrine therapy: a meta-analysis. Onco Targets Ther 2018; 11:8389-8398. [PMID: 30568462 PMCID: PMC6267349 DOI: 10.2147/ott.s166653] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Fulvestrant is recommended for the hormone receptor-positive metastatic breast cancer (MBC) patients progressed during or after prior endocrine therapy. Notably, recent evidence has also demonstrated that adding a targeted agent to fulvestrant conferred a significantly clinical benefit in these patients. Since these results were inconsistent among the studies, this meta-analysis herein was conducted to compare the efficacy and toxicities of the fulvestrant-based combination therapy with fulvestrant monotherapy. Thus, a systemic research was performed in PubMed, Embase, and Cochrane library to identify relevant Phase II or Phase III randomized controlled trials. The progression-free survival (PFS), overall response rate (ORR), and toxicities were evaluated. And HR, risk ratio (RR), and their 95% CIs were employed to complete the pooled analyses. In total, 13 studies with 3,910-hour positive MBC patients progressed on prior endocrine therapy were included in our meta-analysis. Improvements of doublet-agents group were proven in terms of PFS (HR 0.73, 95% CI =0.63–0.86, P=0.000) and ORR (RR 2.07, 95% CI =1.67–2.58, P=0.000). And the further subgroup analysis also demonstrated that fulvestrant in combination with a cyclin-dependent kinase (CDK4/6) inhibitor or a PI3K/mTOR inhibitor was associated with a superior efficacy (RR 2.72, 95% CI =1.93–3.83, P=0.000 and RR 1.60, 95% CI =1.15–2.23, P=0.005, respectively). However, the efficacy was comparable between the other combination strategies and fulvestrant alone. With respect to the adverse effects, adding a targeted agent to fulvestrant also produced more frequent grade 3/4 toxicities (RR 3.86, 95% CI =2.66–5.61, P=0.000). Taken together, combination of fulvestrant with a targeted agent, especially inhibitors targeting CDK4/6 or PI3K/mTOR pathway, may open a new avenue for more effective therapies in relapse or metastatic hormone receptor-positive breast cancer after prior aromatase inhibitors or tamoxifen treatment. In addition, identifying reliable biomarkers to delineate which subgroup of patients will specially benefit from fulvestrant-based combination therapy is warranted.
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Affiliation(s)
- Liang Xu
- The First Department of Prevention and Cure Centre of Breast Disease, The Third Hospital of Nanchang City, Key Laboratory of Breast Disease in Jiangxi Province, Nanchang, JiangXi 330009, China,
| | - Ningning Yan
- Department of Oncology, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Zhihua Li
- The First Department of Prevention and Cure Centre of Breast Disease, The Third Hospital of Nanchang City, Key Laboratory of Breast Disease in Jiangxi Province, Nanchang, JiangXi 330009, China,
| | - Lihua Luo
- Medical Department, Graduate School of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Xiaobo Wu
- The First Department of Prevention and Cure Centre of Breast Disease, The Third Hospital of Nanchang City, Key Laboratory of Breast Disease in Jiangxi Province, Nanchang, JiangXi 330009, China,
| | - Qiuming Liu
- The First Department of Prevention and Cure Centre of Breast Disease, The Third Hospital of Nanchang City, Key Laboratory of Breast Disease in Jiangxi Province, Nanchang, JiangXi 330009, China,
| | - Yingchun Xu
- Department of Oncology, Shanghai Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China,
| | - Yali Cao
- The First Department of Prevention and Cure Centre of Breast Disease, The Third Hospital of Nanchang City, Key Laboratory of Breast Disease in Jiangxi Province, Nanchang, JiangXi 330009, China,
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