OBJECTIVES: To indirectly compare the efficacy (progression free survival (PFS)/time to progression (TTP) and overall survival (OS) of everolimus plus exemestane (EVE+EXE) with fulvestrant in patients with hormone receptor positive, HER2 negative advanced or metastatic breast cancer. METHODS: A systematic search of the Cochrane Library and other resources was undertaken to identify reviews and clinical trials reporting interventions for metastatic breast cancer that would allow an indirect comparison of fulvestrant and EVE+EXE. A Bayesian fixed effect model was used with exemestane adopted as the base treatment for the model because it provided the most information in the network. The basic parameters of the model are the log hazard ratios with respect to exemestane for PFS/TTP and OS from the included studies. In the absence of full networks for TTP/PFS, these outcomes were assumed to be the same measure in a disease with short survival times. RESULTS: Six trials contributed to a network for PFS/TTP and five to a network for OS. Because the comparator treatment was used as the base treatment, a HR > 1 indicates that the comparator is less effective than everolimus. For PFS/TTP, EVE+EXE performed better than fulvestrant 250mg (HR 2.13 Credible interval (CI):1.72 to 2.63) and 500mg (HR 1.69 CI: 1.30 to 2.22). This difference was statistically significant. For OS, EVE+EXE performed better than fulvestrant 250mg (HR 1.36 Cl: 0.95 to 1.97) and 500mg (HR 1.15 Cl: 0.76 to 1.75) but the difference was not statistically significant. A complete statistical assessment of heterogeneity for PFS/TTP and OS was not possible because of data limitations. CONCLUSIONS: EVE+EXE confers better PFS/TTP benefit in HR+ HER2-ve metastatic breast cancer when indirectly compared with fulvestrant 250mg or 500mg. The indirect analysis did not show a statistically significant difference in OS between everolimus compared with fulvestrant.