A MIXED TREATMENT COMPARISON (MTC) TO COMPARE PROGRESSION FREE SURVIVAL (PFS) ASSOCIATED WITH DIFFERENT CHEMOTHERAPY REGIMENS FOR PLATINUM-SENSITIVE OR PARTIALLY PLATINUM-SENSITIVE RECURRENT ADVANCED OVARIAN CANCER
Author(s)
Edwards SJ*;Barton S;Thurgar E;Wakefield V;Karner C, Trevor N BMJ Group, London, United Kingdom
OBJECTIVES: This research was conducted during a review of the manufacturer’s submission (MS) to the NICE Single Technology Appraisal programme for bevacizumab, a vascular endothelial growth factor (VEGF) inhibitor. Bevacizumab in combination with gemcitabine/carboplatin has recently been licensed for use in patients with platinum-sensitive or partially platinum-sensitive recurrent advanced ovarian cancer. This research compared this new triple therapy with treatments used in clinical practice in the UK: platinum monotherapy, gemcitabine/carboplatin, paclitaxel/carboplatin, pegylated liposomal doxorubicin hydrochloride (PLDH)/carboplatin. METHODS: Randomised controlled trials (RCTs) for inclusion were identified using the MS for bevacizumab. RCTs were assessed for comparability based on patient population, disease severity, platinum sensitivity, and treatments received. An MTC was conducted using a Bayesian Markov chain Monte Carlo simulation. Fixed and random effects models were explored with results reported for the best fitting model. Hazard ratio (HR) was chosen as the summary statistic. RESULTS: The network of 6 RCTs formed a linear series of “steps”, which facilitated comparison of all chemotherapy regimens of interest. The fixed effects model was the best-fitting model. There was reasonable agreement between the number of unconstrained data points, residual deviance and pair-wise results, suggesting a coherent network. Using bevacizumab/gemcitabine/carboplatin as the baseline, the results for PFS for the other chemotherapy regimens were: platinum monotherapy (HR 2.92, 95% Credible Interval [CrI]: 2.10 to 3.96), gemcitabine/carboplatin (HR 2.09, 95% CrI: 1.65 to 2.60), paclitaxel/carboplatin (HR 2.16, 95% CrI: 1.50 to 3.01), PLDH/carboplatin (HR 1.77, 95% CrI: 1.20 to 2.51); where a HR>1 favours bevacizumab/gemcitabine/carboplatin and a HR<1 favours the comparator. CONCLUSIONS: This research suggests bevacizumab in combination with gemcitabine/carboplatin may offer significantly longer PFS compared with other chemotherapy options available in the UK.
Conference/Value in Health Info
2013-11, ISPOR Europe 2013, The Convention Centre Dublin
Value in Health, Vol. 16, No. 7 (November 2013)
Code
PCN17
Topic
Clinical Outcomes
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
Oncology