Feasibility Study of a Network Meta-Analysis and Unanchored Population-Adjusted Indirect Treatment Comparison of Niraparib, Olaparib, and Bevacizumab as Maintenance Therapies in Patients with Newly Diagnosed Advanced Ovarian Cancer

Domenica Lorusso, Holly Guy, Yevgeniy Samyshkin, Carol Hawkes, Kasey Estenson, Robert L Coleman, Domenica Lorusso, Holly Guy, Yevgeniy Samyshkin, Carol Hawkes, Kasey Estenson, Robert L Coleman

Abstract

Selecting a first-line (1L) maintenance option for ovarian cancer is challenging given the variety of therapies, differing trials, and the lack of head-to-head data for angiogenesis and poly(ADP-ribose) polymerase (PARP) inhibitors. Thus, indirect treatment comparisons (ITCs) can aid treatment decision making. This study assessed the feasibility of two ITCs, a network meta-analysis (NMA) and a population-adjusted ITC (PAIC), comparing the efficacy of the PARP inhibitor niraparib in the PRIMA trial (NCT02655016) with other 1L maintenance treatments. A systematic literature review was conducted to identify trials using the Cochrane Handbook for Systematic Reviews of Interventions to assess differences in trial design, population characteristics, treatment arms, and outcome measures. All 12 trials identified were excluded from the NMA due to the absence of a common comparator and differences in survival measures and/or inclusion criteria. The PAIC comparing PRIMA and PAOLA-1 trials was also not feasible due to differences in inclusion criteria, survival measures, and the previous receipt of chemotherapy/bevacizumab. Neither ITC met recommended guidelines for analysis; the results of such comparisons would not be considered appropriate evidence when selecting 1L maintenance options in ovarian cancer. ITCs in this setting should be performed cautiously, as many factors can preclude objective trial comparisons.

Keywords: NMA; bevacizumab; first-line maintenance therapy; niraparib; olaparib; ovarian cancer.

Conflict of interest statement

D.L. reports personal fees from AstraZeneca, Clovis Oncology, Genmab, Immunogen, Pharma Mar, Amgen, and Merck, and grants from Pharma Mar and Merck. H.G. reports institutional reimbursements from GlaxoSmithKline. K.E. was an employee and shareholder of GlaxoSmithKline at the time of study. Y.S. and C.H. are employees and shareholders of GlaxoSmithKline. R.L.C. reports consulting fees from Merck, Roche/Genentech, AstraZeneca, Oncomed/Mateo, Novocure, Oncosec, Janssen, Clovis, Tesaro/GSK, AbbVi.e., Eisai, Arrivive, and OncoQuest, grants from Merck, Roche/Genentech, V-Foundation, AstraZeneca, Janssen, Clovis, Genmab, and AbbVie, and honoraria/reimbursement from Merck, Roche/Genentech, AstraZeneca, Oncomed/Mateo, Novocure, Oncosec, Janssen, Clovis, Tesaro/GSK, Eisai, Arrivive, and OncoQuest.

Figures

Figure 1
Figure 1
Example schematics of NMA and anchored or unanchored PAICs. Example schematic of (A) NMA to compare Drugs A, B, and C, (B) anchored PAIC to compare Drugs A and B, and (C) unanchored PAIC to compare Drugs A and B. —indicates direct comparison; —indicates indirect comparison. IPD, individual patient data; NMA, network meta-analysis; PAIC, population-adjusted indirect treatment comparison.
Figure 2
Figure 2
Full potential network of identified RCTs for NMA feasibility [33]. Blue boxes indicate treatment regimens assessed in studies identified in the NMA feasibility analysis. Gray boxes represent RCTs (trial name in bold); studies may have had multiple treatment arms, indicated by multiple branches to blue treatment boxes. The treatment duration of each study is listed in gray boxes. NACT, neoadjuvant chemotherapy; NMA, network meta-analysis; PBO, placebo; RCT, randomized controlled trial; RS, routine surveillance; SC, standard chemotherapy.
Figure 3
Figure 3
Network of identified RCTs for PAIC feasibility. Gray boxes represent RCTs (trial name in bolded text) included in the PAIC feasibility analysis, with treatment duration noted. Blue boxes indicate treatment regimens assessed; studies may have had multiple treatment arms, indicated by multiple branches. PAIC, population-adjusted indirect treatment comparison; PBO, placebo; RCT, randomized controlled trial.

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Source: PubMed

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