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Objective. We aimed to study the efficacy and safety of trastuzumab-emtansine (T-DM1) versus other anti-HER2 therapies in HER2+ breast cancer (BC). Materials and Methods. We performed a network meta-analysis (NMA) of randomized controlled trials (RCTs). Our study focused on patients undergoing treatment for unresectable locally advanced breast cancer (LABC) or metastatic breast cancer (mBC), which included regimens involving trastuzumab and taxanes. Additionally, we considered cases within the first 6 months of treatment for HER2+ early breast cancer (EBC). Results. A total of 23 RCTs and 41 reports were included in our analysis. LABC and mBC showed no statistically significant difference in any of the comparisons of T-DM1 versus the other anti-HER2+ therapies. When assessing progression-free survival (PFS), trastuzumab-deruxtecan (T-DXd) and PyroCap demonstrated greater efficacy compared to other treatments (Hazard Ratio [HR]: 3.57; 95% confidence interval [CI]: 2.75-4.63 and HR: 1.82; 95% CI: 1.35-2.44; respectively), while T-DM1 alone exhibited superior effectiveness compared to LapCap (HR: 0.65; 95% CI: 0.55-0.77), TrasCap (HR: 0.65; 95% CI: 0.46-0.91), LapCapCitu (HR: 0.60; 95% CI: 0.33-1.10), Nera (HR: 0.55; 95% CI: 0.39-0.77), and Cap (HR: 0.37; 95% CI: 0.28-0.49). Conclusions. NMA allows a ranking based on the comparative efficacy and safety among the interventions available. Although superior to other schemes, T-DM1 showed a lower efficacy performance in PFS and overall response rate and a trend towards worse overall survival than T-DXd. [ABSTRACT FROM AUTHOR]

Abstract Background Decisionmakers and guideline developers demand rapid syntheses of the evidence when time sensitive evidence-informed decisions are required. A potential trade-off of such rapid reviews is that their results can have less reliability than results of systematic reviews that can lead to an increased risk of making incorrect decisions or recommendations. We sought to determine how much incremental uncertainty about the correctness of an answer guideline developers and health policy decisionmakers are willing to accept in exchange for a rapid evidence-synthesis. Methods Employing a purposive sample, we conducted an international web-based, anonymous survey of decisionmakers and guideline developers. Based on a clinical treatment, a public health, and a clinical prevention scenario, participants indicated the maximum risk of getting an incorrect answer from a rapid review that they would be willing to accept. We carefully reviewed data and performed descriptive statistical analyses. Results In total, 325 (58.5%) of 556 participants completed our survey and were eligible for analysis. The median acceptable incremental risk for getting an incorrect answer from a rapid review across all three scenarios was 10.0% (interquartile range [IQR] 5.0–15.0). Acceptable risks were similar for the clinical treatment (n = 313, median 10.0% [IQR 5.0–15.0]) and the public health scenarios (n = 320, median 10.0% [IQR 5.0–15.0]) and lower for the clinical prevention scenario (n = 312, median 6.5% [IQR 5.0–10.5]). Conclusions Findings suggest that decisionmakers are willing to accept some trade-off in validity in exchange for a rapid review. Nevertheless, they expect the validity of rapid reviews to come close to that of systematic reviews.

El objetivo fue describir experiencias, barreras y facilitadores en la implementación de intervenciones de control del Aedes aegypti en América Latina y Caribe. Fue realizado un abordaje cualitativo con entrevistas en profundidad semiestructuradas a expertos en implementación de programas (19 participantes de nueve países). Se utilizó un software para la codificar los datos y se confeccionaron matrices para su comparación. En base a los hallazgos desarrollamos una representación gráfica de dimensiones teóricas que agrupan las barreras y facilitadores para la implementación de intervenciones. A nivel global, el ambiente natural y construido contribuye a la reproducción del mosquito. En el sistema de salud, la falta de priorización del problema y la escasez de recursos materiales y humanos representan los obstáculos más importantes. Se necesita que otros sectores diferentes al de salud se responsabilicen de las acciones para mejorar los determinantes sociales de la salud. Existen barreras transversales relacionadas con la gobernanza, como la descoordinación entre los niveles centrales y locales, falta de continuidad de las intervenciones y de los grupos técnicos. La comunidad enfrenta problemas como la falta de información, pobreza o resistencias a recomendaciones. La opinión pública puede tener un impacto positivo o negativo, influyendo indirectamente en las decisiones políticas. Este estudio propone un marco de dimensiones de análisis construido desde los hallazgos; describe factores influyentes en la implementación de políticas que pueden orientar las acciones futuras desde un enfoque integrado.

This article presents the results of a dialogue between decision-makers and experts in Latin America and the Caribbean on priority-setting for interventions and studies on Aedes aegypti control. The article is part of a project that included a systematic review of mosquito control strategies and a qualitative study with key informants from the region. Using a collective deliberative process assisted by the results of the above-mentioned projects, a list of priorities was developed by consensus for the implementation of vector control strategies and the development of key regional research lines. It was agreed that the best strategy is integrated vector management, divided into: (a) chemical control; (b) biological control; (c) environmental management; (d) community participation; and (e) integrated surveillance. The workshop highlighted the crucial role of government leadership and inter-sector coordination between government agencies and civil society stakeholders. The proposed priorities for research lines were: Ae. aegypti vector competence and associated factors; community components of interventions; incorporation of technology into vector control and monitoring; most efficient modalities of integrated surveillance; entomological indicators with the best predictive capacity; and resistance to insecticides. The policy dialogue methodology allowed validating and enriching the results of other levels of research, besides establishing priorities for regional research and control strategies.