Clinical comprehensive evaluation of CDK4/6 inhibitor combined with fulvestrant in HR+/HER2-advanced breast cancer patients
Objective To compare the clinical comprehensive value of four CDK4/6 inhibitors,palbociclib,ribociclib,abemaciclib and dalpiciclib,combined with fulvestrant in the treatment of HR+/HER2-advanced breast cancer,and to provide a reference for the clinical practice and access decision-making.Methods According to the Technical Guidelines for Clinical Comprehensive Evaluation of Antineoplastic Drugs,a clinical comprehensive evaluation index system was constructed from six dimensions:efficacy,safety,cost-effectiveness,suitability,accessibility,and innovativeness.Relevant RCT studies and pharmacoeconomic studies were summarized,and a network meta-analysis was performed to assess the safety and effectiveness of the four CDK4/6 inhibitors combined with fluorouracil.Databases were further searched for additional information to assess each drug's cost-effectiveness,suitability,innovativeness and accessibility.Results In terms of safety,abemaciclib was safer.Dalpiciclib had the best effectiveness profile.Abemaciclib showed advantages in cost-effectiveness and had broader indications and higher suitability.Abemaciclib was also superior in accessibility,with better affordability and availability.In terms of innovativeness,the patent value of palbociclib and dalpiciclib were higher,and abemaciclib had a wider range of target.Conclusion Abemaciclib had the highest overall clinical value,with good effectiveness,safety,cost-effectiveness,suitability,accessibility,and innovativeness compared to palbociclib,ribociclib,and dalpiciclib.
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