Bayesian network meta-comparison of maintenance treatments for stage IIIb/IV non- small-cell lung cancer (NSCLC) patients with good performance status.

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Bayesian network meta-comparison of maintenance treatments for stage IIIb/IV non- small-cell lung cancer (NSCLC) patients with good performance status not progressing after first-line induction chemotherapy: Results by performance status, EGFR mutation, histology and response to previous induction Pui San Tan, Gilberto Lopes, Sanchalika Acharyya, Marcel Bilger, Benjamin Haaland European Journal of Cancer Volume 51, Issue 16, Pages 2330-2344 (November 2015) DOI: 10.1016/j.ejca.2015.07.007 Copyright © 2015 The Authors Terms and Conditions

Fig. 1 Search strategy diagram for trials evaluating maintenance treatments in good performance status stage IIIb/IV non-small-cell lung cancer (NSCLC) patients not progressing after first-line induction based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [34] guidelines. aAVAPERL [35,36] and ATLAS [37,38] were not included in the network meta-analysis as there was no common comparator arm with other included maintenance trials. European Journal of Cancer 2015 51, 2330-2344DOI: (10.1016/j.ejca.2015.07.007) Copyright © 2015 The Authors Terms and Conditions

Fig. 2 Trials included in network meta-analysis evaluating maintenance treatments in good performance status stage IIIb/IV non-small-cell lung cancer (NSCLC) patients not progressing after first-line induction. Thicknesses of lines are proportional to the number of trials included in analyses. aIFCT-GFPC 0502 [17] was a three-arm trial comparing switch to erlotinib, continue gemcitabine and no maintenance. European Journal of Cancer 2015 51, 2330-2344DOI: (10.1016/j.ejca.2015.07.007) Copyright © 2015 The Authors Terms and Conditions

Fig. 3 Overall survival by Eastern Cooperative Oncology Group (ECOG) performance status (PS) and epidermal growth factor receptor (EGFR) mutation status for maintenance treatments in good performance status stage IIIb/IV non-small-cell lung cancer (NSCLC) patients not progressing after first-line induction. Treatments were compared to no maintenance. aBayesian network estimates reported as hazard ratio (95% credible intervals in black and 95% predictive intervals in red). bSwitch pemetrexed [39] and continue pemetrexed [9,46] estimates were estimated from trials results within the nonsquamous population. cTKI estimates by PS were in a predominantly Caucasian population. TKI, tyrosine kinase inhibitors; HR, hazard ratio. European Journal of Cancer 2015 51, 2330-2344DOI: (10.1016/j.ejca.2015.07.007) Copyright © 2015 The Authors Terms and Conditions

Fig. 4 Overall survival by histology and induction response for maintenance treatments in good performance status stage IIIb/IV non-small-cell lung cancer (NSCLC) patients not progressing after first-line induction. Treatments were compared to no maintenance. Estimate for switch docetaxel in the nonsquamous population was an indirect comparison compared to no maintenance computed from Karayama et al. [45] which compared switch docetaxel to continue pemetrexed. aBayesian network estimates reported as hazard ratio (95% credible intervals in black and 95% predictive intervals in red). bTKI estimates by histology and induction response were in a predominantly Caucasian population. cSwitch pemetrexed [39] and continue pemetrexed [9,46] estimates by induction response subgroups were estimated from trials results within the nonsquamous population. CR/PR, complete or partial response to previous induction; SD, stable disease post-induction; TKIs, tyrosine kinase inhibitors; HR, hazard ratio. European Journal of Cancer 2015 51, 2330-2344DOI: (10.1016/j.ejca.2015.07.007) Copyright © 2015 The Authors Terms and Conditions

Fig. 5 Surface under the cumulative ranking (SUCRA) curve of overall survival by Eastern Cooperative Oncology Group (ECOG) performance status (PS), histology, and response to induction for maintenance treatments in good performance status stage IIIb/IV non-small-cell lung cancer (NSCLC) patients not progressing after first-line induction. As an illustration (solid line, PS 0 panel), switch to pemetrexed had 63% probability of being the best maintenance for overall survival (OS) benefit, 85% probability of being among two best maintenance, 94% probability of being among the three best, and >99% probability of being among the four best, with average of these cumulative rank probabilities represented by SUCRA 85.4%. Mid-point step intervals were taken for each rank on the x-axis [21]. SUCRA plots by epidermal growth factor receptor (EGFR) mutation were not illustrated as there were only two treatment comparisons. aSwitch to pemetrexed [39] and continue pemetrexed [9,46] estimates by performance status (PS) and induction response were estimated from trials results within the nonsquamous population. bTyrosine kinase inhibitor (TKI) estimates by PS, histology and induction response were in a predominantly Caucasian population. European Journal of Cancer 2015 51, 2330-2344DOI: (10.1016/j.ejca.2015.07.007) Copyright © 2015 The Authors Terms and Conditions