Lee Cho-Hao, Kang Yi-No, Ho Ching-Liang, Lin Chin, Chen Po-Huang, Wu Yi-Ying, Huang Tzu-Chuan
Division of Hematology and Oncology Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center.
Center for Evidence-Based Medicine, Department of Education, Taipei Medical University Hospital.
Medicine (Baltimore). 2020 Mar;99(13):e19618. doi: 10.1097/MD.0000000000019618.
Recently, many endocrine therapies have become available for hormone receptor-positive, human epidermal growth factor receptor 2-negative, pretreated, advanced breast cancer. Direct comparisons of these novel treatments to assess their added value, however, are lacking METHODS:: Our aim was to synthesize available evidence to compare all current endocrine treatments for hormone receptor-positive / human epidermal growth factor receptor 2-negative advanced breast cancer. We performed a systematic review to identify available randomized controlled trial evidence. We searched Embase, MEDLINE, and the Cochrane Central Register of Controlled Clinical Trials. Two trials presented at international oncology congresses (American Society of Clinical Oncology [ASCO]) were added to include the most recent evidence. A frequent network meta-analysis was used, and the surface under cumulative ranking area (SUCRA) was calculated to determine the best treatment RESULTS:: In total, 32 trials and 12,726 patients were identified, including 27 arms. Compared with fulvestrant 500 mg alone, novel target inhibitors combined with fulvestrant or exemestane had significantly prolonged progression-free survival with hazard ratios ranging from 0.62 to 0.82. Fulvestrant 500 mg plus palbociclib 125 mg and exemestane 25 mg plus entinostat 5 mg similarly extended progression-free survival (hazard ratio: 0.64 and 0.62 with SUCRA values of 91% and 92%, respectively). The exemestane 25 mg plus everolimus 10 mg combination had the best clinical benefit rate (risk ratio: 1.84, SUCRA: 91%) and overall response rate (risk ratio: 6.05, SUCRA: 97%) CONCLUSIONS:: On the basis of this analysis, the 2 combinations of exemestane plus everolimus and fulvestrant plus palbociclib were the best treatment options.
最近，许多内分泌疗法已可用于激素受体阳性、人表皮生长因子受体2阴性、经预处理的晚期乳腺癌。然而，缺乏对这些新疗法进行直接比较以评估其附加价值的研究。方法：我们的目的是综合现有证据，比较目前用于激素受体阳性/人表皮生长因子受体2阴性晚期乳腺癌的所有内分泌治疗方法。我们进行了一项系统评价，以确定可用的随机对照试验证据。我们检索了Embase、MEDLINE和Cochrane临床对照试验中央注册库。两项在国际肿瘤学大会（美国临床肿瘤学会[ASCO]）上发表的试验也被纳入，以纳入最新证据。采用频繁网络荟萃分析，并计算累积排名曲线下面积（SUCRA）以确定最佳治疗方法。结果：总共确定了32项试验和12726名患者，包括27个治疗组。与单独使用500mg氟维司群相比，新型靶向抑制剂联合氟维司群或依西美坦可显著延长无进展生存期，风险比为0.62至0.82。500mg氟维司群加125mg哌柏西利和25mg依西美坦加5mg恩杂鲁胺同样延长了无进展生存期（风险比分别为0.64和0.62，SUCRA值分别为91%和92%）。25mg依西美坦加10mg依维莫司联合治疗的临床获益率最高（风险比：1.84，SUCRA：91%）和总缓解率最高（风险比：6.05，SUCRA：97%）。结论：基于该分析，依西美坦加依维莫司和氟维司群加哌柏西利这两种联合治疗是最佳治疗选择。
