Matching-adjusted indirect treatment comparison of [177Lu]Lu-DOTA-TATE, everolimus and sunitinib in advanced, unresectable gastroenteropancreatic neuroendocrine tumours: Relative effectiveness of [177Lu]Lu-DOTA-TATE in gastroenteropancreatic neuroendocrine tumours. (November 2021)

• Record Type: Journal Article
• Authors: Khan, Mohid S.; Stamp, Elaine; Sammon, Cormac; Brabander, Tessa; de Herder, Wouter W.; Pavel, Marianne E.
• Is Part Of: EJC supplements. Volume 16(2021)
• Page Start: 5
• Page End: 13
• Publication Date: 2021-11
• Subjects: Overall survival -- Progression-free survival -- Comparative effectiveness -- Best supportive care; Cancer -- Periodicals; Tumors -- Periodicals; Neoplasms -- Periodicals; Cancer; Tumors; Periodicals; Electronic journals; Electronic journals; 616.994
• DOI: 10.1016/j.ejcsup.2021.06.002
• Languages: English
• ISSNs: 1359-6349

Abstract

Abstract: Head-to-head comparisons of the efficacy of treatments for gastroenteropancreatic neuroendocrine tumours (GEP-NETs) have not yet been reported. This study used a series of matching-adjusted indirect comparisons to indirectly compare the effectiveness of [ 177 Lu]Lu-DOTA-TATE to everolimus, sunitinib and best supportive care (BSC) for extending progression-free survival and overall survival in patients with advanced, unresectable gastrointestinal (GI)-NETs and P-NETs. The results of the main analysis suggest that after accounting for differences in key prognostic variables, the hazard of progression was 62% (hazard ratio [HR], 0.38; confidence interval [CI]95 0.25–0.58) and 65% (HR 0.35 CI95 0.21–0.59) lower in patients with GI-NETs treated with [ 177 Lu]Lu-DOTA-TATE than in those treated with everolimus and BSC, respectively. Similarly, the hazard of progression was 64% (HR 0.36 CI95 0.18–0.70), 54% (HR 0.46 CI95 0.30–0.71) and 79–87% (HR 0.21 CI95 0.13–0.32; HR 0.13 CI95 0.08–0.22) lower in patients with P-NET treated with [ 177 Lu]Lu-DOTA-TATE than in those treated with sunitinib, everolimus and BSC, respectively. The hazard of death was 58% (HR 0.42 CI95 0.25–0.72), 47% (HR 0.53 CI95 0.33–0.87) and 44–64% (HR 0.56 CI95 0.36–0.90; HR 0.34 CI95 0.20–0.57) lower in P-patients with NET treated with [ 177 Lu]Lu-DOTA-TATE than in those treated with sunitinib, everolimus and BSC, respectively. While our results must be interpreted with caution given the non-randomised nature of the comparisons and the potential for residual confounding, the magnitude of the effect sizes we observe and their consistency across comparators suggest that [ 177 Lu]Lu-DOTA-TATE may be a more effective treatment option than everolimus, sunitinib and BSC in advanced, unresectable GEP-NETs. Highlights: The study reports unanchored indirect comparisons of treatments in GI- and P-NETs. 177Lu-DOTATATE was compared with everolimus, sunitinib and supportive care. GI- and P-NETs patients treated with 177Lu-DOTATATE had lower hazard of progression. Patients with P-NET treated with 177Lu-DOTATATE had lower hazard of death. Results must be interpreted with caution given potential for residual confounding.