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. 2018 Jan;25(1):8-16.
doi: 10.1007/s12282-017-0794-8. Epub 2017 Jul 28.

Adjuvant endocrine monotherapy for postmenopausal early breast cancer patients with hormone-receptor positive: a systemic review and network meta-analysis

Zhu Yu  1 , Xiaojing Guo  1 , Yicheng Jiang  1 , Lei Teng  1 , Jinwu Luo  1 , Pengfei Wang  1 , Yunsheng Liang  1 , Haitian Zhang  2
Affiliations

Adjuvant endocrine monotherapy for postmenopausal early breast cancer patients with hormone-receptor positive: a systemic review and network meta-analysis

Zhu Yu et al. Breast Cancer. 2018 Jan.

Abstract

Background: In patients with hormone receptor-positive postmenopausal of early stage breast cancer, adjuvant endocrine monotherapies include letrozole, anastrozole, exemestane, toremifene and tamoxifen. But the optimum regimen remains controversial.

Methods: PubMed, Cochrane Database and ClinicalTrials.gov were systematically reviewed of abstract for randomized-controlled trials (RCTs) to assess the efficacy of tamoxifen, letrozole, exemestane, anastrozle and toremifene for postmenopausal patients with hormone-receptor positive (HR+), who have not received prior therapy for early stage breast cancer. The outcomes were measured by disease-free survival (DFS) and overall survival (OS). We evaluated relative hazard ratios (HRs) for death of different therapies by combination hazard ratios for death of included trials. The SUCRA values were used to evaluate the rankings of efficacy for these monotherapies.

Results: A total of fourteen studies including 19,517 patients in our research were absorbed and estimated. The superiority of efficacy for DFS were 5-year letrozole and 10-year tamoxifen (SUCRA values 0.743/0.657) in all comparisons. A more efficient SUCRA values for OS were 5-year Exemestane, 5-year letrozole and 10-year tamoxifen (0.756/0.677/0.669).

Conclusions: Clinically important differences exist between commonly prescribed different adjuvant endocrine monotherapy regimens for both efficacy and acceptability in favor of exemestane and letrozole. 10-year tamoxifen for early breast cancer patients is noninferior to 5-year anastrozle, and might be the best choice where aromatase inhibitors (AIs) are not easy to acquire.

Keywords: Early breast cancer; Endocrine monotherapy; Network meta-analysis; Postmenopausal women.

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Conflict of interest statement

All other authors declared no competing of interest.

Figures

Fig. 1
Fig. 1
Flow of information through the different phases of the network meta-analysis
Fig. 2
Fig. 2
Cochrane risk of bias tool assessment (+: low risk of bias; −: high risk of bias; ?: unclear risk of bias). Other bias: percentage of post-menopausal and HR(+): low risk: ≧50%; high risk of bias: <50%; unclear risk of bias: not mentioned in the article
Fig. 3
Fig. 3
Network of analyzed comparisons. The notes size of DFS (a) and OS (b) are thickness of the line corresponding to the number of trial per comparison
Fig. 4
Fig. 4
Ranking of interventions with respect to the DFS (a) and OS (b): SUCRA values
See this image and copyright information in PMC

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