TYROSINE KINASE INHIBITORS (TKI) FOR THE TREATMENT OF ADVANCED MEDULLARY THYROID CARCINOMA- A SYSTEMATIC REVIEW AND INDIRECT COMPARISON
Author(s)
Kawalec P
Jagiellonian University Medical College, Krakow, Poland
OBJECTIVES: We attempted to identify the preferable tyrosine kinase inhibitor (TKI) for the treatment of adult patients with advanced medullary thyroid cancer (MTC) based on available clinical evidence METHODS: Electronic databases were searched up till January 2016 for clinical trials of cabozantinib in advanced MTC and controlled clinical trials of vandetanib in the treatment of advanced MTC. Predefined outcomes of interest were: overall survival (OS), progression-free survival (PFS), objective response rate (ORR) and safety profile. Adjusted indirect comparison of efficacy and safety of TKIs was performed by Bucher method after trials included homogeneity assessment RESULTS: Two completed and two not-completed studies for cabozantinib (EXAM) and one trial for vandetanib (ZETA) were included. The results of phase III trial showed that cabozantinib treatment significantly prolongs the progression free survival (PFS) and increases the objective response rate (ORR) compared to placebo, without deterioration of the quality of life as measured by disease specific instrument. Indirect comparison showed no significant differences between efficacy of cabozantinib and vandetanib. Relative to control PFS and ORR were similar for both TKIs, although between trials significant differences were observed in studies’ design, which could introduce a bias to results of indirect comparison. Safety profile of TKIs was comparable. CONCLUSIONS: Cabozantinib is the first drug with strong evidence on efficacy in treatment of progressive MTC. Safety profile of cabozantinib was defined as acceptable. No reliable evidence concerning preferable TKI in the treatment of advanced MTC was identified. Based on the available clinical data the similar efficacy and safety of cabozantinib and vandetanib was concluded, although a trend towards cabozantinib in PFS was observed.
Conference/Value in Health Info
2016-10, ISPOR Europe 2016, Vienna, Austria
Value in Health, Vol. 19, No. 7 (November 2016)
Code
PCN4
Topic
Clinical Outcomes, Epidemiology & Public Health
Topic Subcategory
Comparative Effectiveness or Efficacy, Safety & Pharmacoepidemiology
Disease
Oncology