Ross School of Business, University of Michigan, 701 Tappan Street R5468, Ann Arbor, MI, 48109, USA.
Sloan School of Management, MIT, Operations Research Center, E40-111, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA.
Breast Cancer Res Treat. 2019 Aug;176(3):535-543. doi: 10.1007/s10549-019-05208-w. Epub 2019 May 14.
Oncologists, clinical trialists, and guideline developers need tools that enable them to efficiently review the settings and results of previous studies testing metastatic breast cancer (MBC) drug therapies.
We searched the literature to identify clinical trials testing MBC drug therapies. Key eligibility criteria included at least 90% of patients enrolled in the trial having MBC, therapeutic clinical trials, and Phase II-III studies. Studies were stratified based on patients' tumor receptor statuses and prior exposure to therapy. Survival and toxicity of each drug therapy were estimated from randomized controlled trials using network meta-analysis and from all studies using meta-analysis. These results, along with estimated drug costs, are presented in a web-based visualization tool.
We included 1865 studies containing 2676 treatment arms and 184,563 patients in the tool ( http://www.cancertrials.info ). Meta-analysis-based efficacy and toxicity estimates are available for 85 HER-2-directed therapies, 84 hormonal therapies, and 442 undirected therapies. Network meta-analysis-based estimates are available for 16 HER-2-directed therapies, 26 hormonal therapies, and 131 undirected therapies.
In this era of increasing choices of MBC therapeutic agents and no superior approach to choosing a treatment regimen, the ability to compare multiple therapies based on survival, toxicity and cost would enable treating physicians to optimize therapeutic choices for patients. For investigators, it can point them in research directions that were previously non-obvious and for guideline designers, enable them to efficiently review the MBC clinical trial literature and visualize how regimens compare in the key dimensions of clinical benefit, toxicity, and cost.
肿瘤学家、临床试验专家和指南制定者需要能够高效地评估先前测试转移性乳腺癌（MBC）药物治疗的研究的设定和结果的工具。
我们检索了文献，以确定测试 MBC 药物治疗的临床试验。关键入选标准包括至少 90%的入组患者患有 MBC、治疗性临床试验和 II-III 期研究。研究根据患者的肿瘤受体状态和先前的治疗暴露情况进行分层。使用网络荟萃分析从随机对照试验中以及使用荟萃分析从所有研究中估算每种药物治疗的生存和毒性。这些结果以及估计的药物成本将在一个基于网络的可视化工具中呈现。
我们在工具中纳入了 1865 项研究，包含 2676 个治疗臂和 184563 例患者（http://www.cancertrials.info）。基于荟萃分析的疗效和毒性评估结果可用于 85 种 HER-2 靶向治疗药物、84 种激素治疗药物和 442 种非靶向治疗药物。基于网络荟萃分析的评估结果可用于 16 种 HER-2 靶向治疗药物、26 种激素治疗药物和 131 种非靶向治疗药物。
在当前 MBC 治疗药物选择增多而没有优选治疗方案的情况下，能够基于生存、毒性和成本比较多种治疗方法的能力将使治疗医生能够为患者优化治疗选择。对于研究人员来说，它可以为他们指明以前不明显的研究方向，对于指南制定者来说，可以使他们能够高效地评估 MBC 临床试验文献，并直观地了解治疗方案在临床获益、毒性和成本方面的比较情况。
