Meta-analysis: CDK4/6 inhibitors + hormone therapy best for HR+ metastatic breast cancer

  • The Lancet

  • curated by Miriam Davis, PhD
  • Univadis Clinical Summaries
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Takeaway

  • A network meta-analysis finds that CDK4/6 inhibitors plus endocrine therapies (ET) are superior to ET alone for PFS in patients with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer.
  • CDK4/6 inhibitors with ET are also superior to any chemotherapy with or without targeted therapy (CDK4/6 inhibitor or everolimus) for PFS.

Why this matters

  • This is the first network meta-analysis of its kind to incorporate the latest clinical trials.

Study design

  • Network meta-analysis of 140 studies (n=50,029) after search of PubMed, Embase, Cochrane Central Register of Clinical Trials, Web of Science, and international oncology conferences.
  • Funding: None.

Key results

  • The following therapies had better PFS than anastrozole alone:
    • Palbociclib+letrozole (HR, 0.42; 95% credible interval [CrI], 0.25-0.70).
    • Ribociclib+letrozole (HR, 0.43; 95% CrI, 0.24-0.77).
    • Abemaciclib+anastrozole or letrozole (HR, 0.42; 95% CrI, 0.23-0.76).
    • Palbociclib+fulvestrant (HR, 0.37; 95% CrI, 0.23-0.59).
  • No chemotherapy or hormone therapy was better than palbociclib+letrozole for PFS.
  • Paclitaxel+bevacizumab was better than palbociclib+letrozole in terms of the proportion of patients achieving an overall response (OR, 8.95; 95% CrI, 1.03-76.92).

Limitations

  • Unable to perform separate analyses for first-line, second-line, and subsequent lines of therapy.

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