EVALUATING THE CLINICAL EFFECTIVENESS OF TRASTUZUMAB EMTANSINE (T-DM1) VERSUS ALL OTHER TREATMENTS FOR PREVIOUSLY TREATED, UNRESECTABLE, HER2-POSITIVE METASTATIC BREAST CANCER (MBC)- A MIXED TREATMENT COMPARISON (MTC)
Author(s)
Paracha N, Irahara N, Schuhmacher C
F. Hoffmann-La Roche Ltd, Basel, Switzerland
Presentation Documents
OBJECTIVES: T-DM1 is approved for the treatment of MBC in patients previously treated with trastuzumab+taxane. We compared the clinical effectiveness of T-DM1 with all other therapies in patients with previously treated, unresectable, HER2-positive locally advanced breast cancer (LABC) or MBC. METHODS: A systematic review was conducted that included all published data between January 1, 1998 and June 30, 2016. Eligible trials were controlled trials of pharmacological treatments for unresectable HER2-positive LABC or MBC that had progressed after treatment with trastuzumab+taxane in the MBC setting or with fast relapse (within 6 months) following adjuvant therapy. A Bayesian and frequentist MTC of progression-free survival (PFS) and overall survival (OS) was conducted on a log hazard scale. Hazard ratios (HRs) were estimated using both fixed- and random-effects models. Treatment switching–adjusted OS estimate was used as a sensitivity analysis where applicable. Models were compared using residual deviance (RD) and deviance information criteria (DIC). RESULTS: Six randomized trials met the inclusion criteria. The fixed-effects model was preferred, as the difference in RD and DIC between the fixed- and random-effects models was less than 1 point. Both frequentist and Bayesian fixed-effect models provided similar results. T-DM1 demonstrated substantial reduction in the risk of PFS and OS (HR [95% credible interval]) when compared with lapatinib+capecitabine (PFS 0.65 [0.55–0.77]; OS 0.75 [0.64–0.88]), trastuzumab+capecitabine (PFS 0.67 [0.50–0.90]; OS 0.78 [0.55–1.10]), capecitabine monotherapy (PFS 0.40 [0.29–0.54]; OS 0.67 [0.52–0.87]), and neratinib monotherapy (PFS 0.55 [0.39–0.77]; OS 0.60 [0.39–0.93]). When compared with pertuzumab+trastuzumab+capecitabine, T-DM1 had a PFS HR of 0.82 (0.56–1.19) and OS HR of 1.15 (0.73–1.79). CONCLUSIONS: The results of this MTC showed greater PFS and OS benefit for T-DM1 versus lapatinib+capecitabine, trastuzumab+capecitabine, capecitabine monotherapy, and neratinib monotherapy in patients with previously treated HER2-positive LABC or MBC.
Conference/Value in Health Info
2017-11, ISPOR Europe 2017, Glasgow, Scotland
Value in Health, Vol. 20, No. 9 (October 2017)
Code
PCN26
Topic
Clinical Outcomes
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
Oncology