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Systematic Review

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

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Fondazione Policlinico Gemelli of Rome, 00168 Rome, Italy
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Department of Gynecologic Oncology, Catholic University of Sacred Heart, 00168 Rome, Italy
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FIECON Ltd., St Albans AL3 4PA, UK
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GlaxoSmithKline, Brentford TW8 9GS, UK
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GlaxoSmithKline, Philadelphia, PA 19112, USA
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Eisai Inc., Nutley, NJ 07677, USA
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Texas Oncology, US Oncology Research, The Woodlands, TX 77380, USA
*
Author to whom correspondence should be addressed.
Academic Editors: Charles Theillet and Bo Ruben Rueda
Cancers 2022, 14(5), 1285; https://doi.org/10.3390/cancers14051285
Received: 23 December 2021 / Revised: 22 February 2022 / Accepted: 23 February 2022 / Published: 2 March 2022
Ovarian cancer (OC) is a leading cause of cancer-related death and 85% of women with advanced OC relapse after chemotherapy. First-line (1L) maintenance therapy is given to prolong the benefit of chemotherapy. However, selection of a 1L maintenance therapy is challenging given the number of therapies available and the lack of clinical trials that directly compare these therapies. Indirect treatment comparisons (ITCs) allow the comparison of therapies across trials and may inform selection of the most appropriate treatment option. ITCs must follow statistical principles to ensure similarity among trials and allow for a fair comparison. This study assessed whether two types of ITC could be performed to compare the poly(ADP-ribose) polymerase inhibitor niraparib with other 1L maintenance therapies. The 12 clinical trials assessed differed too significantly to meet recommended criteria for comparison. This study highlights the need for caution when comparing trial data to inform treatment decisions.
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. View Full-Text
Keywords: ovarian cancer; first-line maintenance therapy; niraparib; bevacizumab; NMA; olaparib ovarian cancer; first-line maintenance therapy; niraparib; bevacizumab; NMA; olaparib
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MDPI and ACS Style

Lorusso, D.; Guy, H.; Samyshkin, Y.; Hawkes, C.; Estenson, K.; Coleman, R.L. 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. Cancers 2022, 14, 1285. https://doi.org/10.3390/cancers14051285

AMA Style

Lorusso D, Guy H, Samyshkin Y, Hawkes C, Estenson K, Coleman RL. 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. Cancers. 2022; 14(5):1285. https://doi.org/10.3390/cancers14051285

Chicago/Turabian Style

Lorusso, Domenica, Holly Guy, Yevgeniy Samyshkin, Carol Hawkes, Kasey Estenson, and Robert L. Coleman. 2022. "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" Cancers 14, no. 5: 1285. https://doi.org/10.3390/cancers14051285

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