Treatment options for patients with hormone receptor (HR)-positive metastatic breast cancer (MBC) and prior treatment with aromatase inhibitors (AIs) include everolimus/exemestane (EE) or palbociclib/fulvestrant (PF). To date, no direct comparison has been presented between EE and fulvestrant plus CDK4/6 inhibitors in this setting. The objective of this study was to compare the efficacy of EE versus PF, abemaciclib/fulvestrant (AF), or everolimus/fulvestrant (EF) in the treatment of metastatic HR-positive, HER2-negative MBC previously treated with AIs.1 To this end, an indirect comparison was performed with a network meta-analysis comparing EE with PF, AF, or EF in the treatment of metastatic HR-positive, HER2-negative MBC pretreated with AIs. Progression-free survival was the primary end point of all indirect comparisons, with efficacy data expressed as a hazard ratio and 95% confidence interval (CI).
All data from the BOLERO-2 trial,2 a network meta-analysis,3 the PALOMA-3,4 MONARCH 2,5 and prECOG trials6 were analyzed and indirectly compared in a network meta-analysis. The investigators performed 6 orders of comparison: AF versus PF, PF versus EE, AF versus EE, EF versus AF, EF versus PF, and EF versus EE. The pooled hazard ratio and 95% CI are reported in the Table.
To date, EE and PF have represented active and approved treatments for patients with metastatic HR-positive, HER2-negative breast cancer treated with AIs. Previous studies have shown that combination hormone therapies with everolimus or CDK4/6 inhibitors are better than hormone therapy alone; however, no direct comparisons between these treatment combinations exist in the literature. The results of the present indirect treatment comparisons suggest that EE is similar and, in some cases, maybe even more effective than other treatment options. The optimal treatment strategy and sequence for patients with MBC and prior treatment with AIs should be evaluated in clinical trials. Meanwhile, these data could be considered together with safety and an economic profile to help physicians select optimal, value-based options in clinical practice.
- Arcangeli GL, et al. SABCS 2017. Abstract P3-11-05.
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- Telli ML, et al. J Clin Oncol. 2015;33:1895-1901.