Evidence mapPaperPMID 32847835Full record

SynthesisESMO open2020

Endocrine therapy-based treatments in hormone receptor-positive/HER2-negative advanced breast cancer: systematic review and network meta-analysis.

Mariana Brandão, Christian Maurer, Patricia Klarmann Ziegelmann, Noam F Pondé, Arlindo Ferreira, Samuel Martel, Martine Piccart, Evandro de Azambuja, Márcio Debiasi, Matteo Lambertini

Open access · goldAbstract readSystematic ReviewNetwork Meta-Analysis
In one paragraph

Synthesis in ESMO open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
19citing papers in PubMed, 2 pooled it
2.0field-weighted citation impact, top 11% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

19 citing papers in PubMed, 2 syntheses or guidelines pooled it, 29 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Observational
  4. Review
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  6. Review
  7. Quantitative [Journal of nuclear medicine : official publication, Society of Nuclear Medicine · 2025
    Article
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  15. Observational
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  19. Prognostic Value of theCancer management and research · 2021
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 8 institutions in 6 countries.

Mariana BrandãoAcademic Trials Promoting Team, Institut Jules Bordet, Bruxelles, Belgium.ORCID 0000-0002-1653-3544
Christian MaurerDepartment I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany.ORCID 0000-0003-4388-5163
Patricia Klarmann ZiegelmannNational Institute for Health Technology Assessment (IATS), Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.ORCID 0000-0002-2851-2011
Noam F PondéMedical Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil.ORCID 0000-0002-1046-6352
Arlindo FerreiraBreast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal.ORCID 0000-0002-1567-9322
Samuel MartelInstitut Jules Bordet, Bruxelles, Belgium.ORCID 0000-0002-8461-7256
Martine PiccartUniversité Libre de Bruxelles, Institut Jules Bordet, Bruxelles, Belgium.
Evandro de AzambujaAcademic Trials Promoting Team, Institut Jules Bordet, Bruxelles, Belgium.ORCID 0000-0001-9501-4509
Márcio DebiasiBreast International Group, Brussels, Belgium.ORCID 0000-0002-7265-7533
Matteo LambertiniDepartment of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy matteo.lambertini@unige.it.ORCID 0000-0003-1797-5296
Institut Jules Bordet · BEAC Camargo Hospital · BRBreast International Group · BEChampalimaud Foundation · PTOspedale Policlinico San Martino · ITUniversidade Federal do Rio Grande do Sul · BRUniversité Libre de Bruxelles · BEUniversity of Cologne · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSeveral endocrine therapy (ET)-based treatments are available for patients with advanced breast cancer. We assessed the efficacy of different ET-based treatments in patients with hormone receptor-positive/HER2-negative advanced breast cancer with endocrine-sensitive or endocrine-resistant disease.

methodsWe searched Medline and Cochrane Central Register of Controlled Trials up to 15 October 2019 and abstracts from major conferences from 2016 to October 2019. We included phase II/III randomised trials, comparing ≥2 ET-based treatments. Progression-free survival (PFS) and overall survival (OS) were analysed by network meta-analyses using MTC Bayesian models based on both fixed-effect and random-effect models; relative treatment effects were measured as HRs and 95% credibility intervals (CrI). All statistical tests were two-sided. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed and this systematic review is registered in the PROSPERO database.

results55 publications reporting on 32 trials (n=12 293 patients) were included. Regarding PFS in the endocrine sensitive setting (n=5200; 12 trials), the combination of cyclin-dependent kinases (CDK)4/6-inhibitors (CDK4/6i)+fulvestrant 500 mg (F500) was likely the most effective treatment (surface under the cumulative ranking curve (SUCRA)=97.3%), followed by CDK4/6i+aromatase inhibitor ±goserelin; there was no significant difference between them (HR 0.82; 95% CrI 0.54-1.25). Regarding OS (n=2157; five trials), the most effective treatment was probably CDK4/6i+F500 (SUCRA=97.3%); comparing CDK4/6i+F500 versus F500 held a HR of 0.77 (95% CrI 0.63-0.95). Regarding PFS in the endocrine-resistant setting (n=6635; 20 trials), CDK4/6i+F500 was likely the most effective treatment (SUCRA=95.7%), followed by capivasertib+F500, without significant difference between them (HR 0.91; 95% CrI 0.60-1.36). For OS (n=4377; 11 trials), the most effective treatments were capivasertib+F500 (SUCRA=84.7%) and CDK4/6i+F500 (SUCRA=69.9%). Comparing CDK4/6i+F500 versus F500 held a HR of 0.77 (95% CrI 0.67-0.89).

conclusionsCDK4/6i+F500 is likely the best treatment option in both endocrine-sensitive and endocrine-resistant diseases for PFS, and in endocrine-sensitive patients for OS. Concerning OS in endocrine-resistant patients, capivasertib+F500 and CDK4/6i+F500 are likely the best treatments. PROSPERO REGISTRATION NUMBER: CRD42018104628.

Indexed as

Breast NeoplasmsBayes TheoremCyclin-Dependent Kinase 4Cyclin-Dependent Kinase 6Erb-b2 Receptor Tyrosine KinasesFemaleFulvestrantHumansReceptors, EstrogenCyclin-Dependent Kinase 4Cyclin-Dependent Kinase 6Erb-b2 Receptor Tyrosine KinasesFulvestrantReceptors, Estrogenbreast neoplasmsendocrine therapymolecular targeted therapynetwork meta-analysissystematic review

Identifiers

PMID32847835
PMCPMC7451473
OpenAlexW3080816877

What Socratic holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.