title: Network Meta-Analysis Comparing Overall Survival for Fulvestrant 500 mg Versus Alternative Therapies for Treatment of Postmenopausal, Estrogen Receptor-Positive Advanced Breast Cancer Following Failure on Prior Endocrine Therapy.
abstract: We conducted a review of randomized trials to compare the overall survival (OS) with fulvestrant 500 mg versus alternative treatment for estrogen receptor-positive advanced breast cancer following endocrine therapy failure.
  
  
  
  Hazard ratios (HRs) were obtained by modeling OS data with the Weibull distribution. A fixed-effect Bayesian network meta-analysis was conducted. The evidence network included anastrozole 1 mg, letrozole 2.5 mg, fulvestrant 250 mg, exemestane 25 mg, megestrol acetate 40 mg, and everolimus 10 mg plus exemestane 25 mg as comparators. Post-antiestrogen and post-aromatase inhibitor subgroup networks were analyzed.
  
  
  
  In the overall analysis, the HRs suggested improved OS for fulvestrant 500 mg versus fulvestrant 250 mg and megestrol acetate 40 mg, and numerically favorable differences with fulvestrant 500 mg versus other comparators. In the antiestrogen subgroup, the HRs suggested improved OS for fulvestrant 500 mg versus fulvestrant 250 mg and megestrol acetate 40 mg; numerical differences in the HRs were seen versus anastrozole 1 mg and letrozole 2.5 mg. In the aromatase inhibitor subgroup, the HRs for OS numerically favored fulvestrant 500 mg versus fulvestrant 250 mg and exemestane 25 mg.
  
  
  
  Acknowledging the limitations of the present network meta-analysis, these findings suggest that fulvestrant 500 mg might provide improved OS versus fulvestrant 250 mg and megestrol acetate 40 mg for treatment of estrogen receptor-positive ABC following endocrine therapy failure. Although OS efficacy versus everolimus 10 mg plus exemestane 25 mg (for overall evidence network), anastrozole 1 mg, exemestane 25 mg, and letrozole 2.5 mg is numerically favorable, additional studies are required to draw formal conclusions.
authors.affiliation: AstraZeneca Pharmaceuticals, Global Payer Evidence & Pricing, Gaithersburg, MD. Electronic address: claire.telford@astrazeneca.com.
authors.forename: Claire
authors.initials: C
authors.lastname: Telford
authors.affiliation: AstraZeneca Pharmaceuticals, Global Payer Evidence & Pricing, Gaithersburg, MD.
authors.forename: Nick
authors.initials: N
authors.lastname: Jones
authors.affiliation: DRG Abacus, Bicester, United Kingdom.
authors.forename: Christopher
authors.initials: C
authors.lastname: Livings
authors.affiliation: DRG Abacus, Bicester, United Kingdom.
authors.forename: Sarah
authors.initials: S
authors.lastname: Batson
mesh_terms: D000077384:Anastrozole; D000730:Androstadienes / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D047072:Aromatase Inhibitors / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D004958:Estradiol / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000068338:Everolimus / Q000627:therapeutic use; D005260:Female; D000077267:Fulvestrant; D006801:Humans; D000077289:Letrozole; D019290:Megestrol Acetate / Q000627:therapeutic use; D009570:Nitriles / Q000627:therapeutic use; D017698:Postmenopause; D011960:Receptors, Estrogen / Q000096:biosynthesis; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use
chemical_list: D000730:Androstadienes; D000970:Antineoplastic Agents; D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors; D009570:Nitriles; D011960:Receptors, Estrogen; D014230:Triazoles; D000077267:Fulvestrant; D000077384:Anastrozole; D004958:Estradiol; D000077289:Letrozole; D000068338:Everolimus; C056516:exemestane; D019290:Megestrol Acetate
keywords: Aromatase inhibitor; Hormone therapy; Indirect treatment comparison; Progression; Selective estrogen receptor degrader