Data from RCTs that met the eligibility criteria were extracted by one reviewer, and a second reviewer validated the extraction for accuracy. Data fields of interest included study design (e.g., trial phase and blinding), methods, sample size, disease and patient characteristics, intervention details (e.g., dosage, schedule), study follow-up and assessment time periods, and efficacy and safety outcomes. The quality of RCTs was assessed using the Centre for Reviews and Dissemination tool according to the National Institute for Health and Care Excellence (NICE) Guide to the Methods of Technology Appraisal [9].

Evidence identified from the SLR was assessed to determine the feasibility of comparing efficacy and safety estimates via an NMA. The network of evidence for each outcome of interest was assessed, and the need for and validity of any assumptions required to connect the network was evaluated. Specifically, the feasibility assessment evaluated whether RCTs were comparable with regards to factors that impact the relative effect of each of the treatments on each outcome, including patient-level characteristics, relevancy of interventions (comparable dosage and schedules), availability of outcome data overall and by subgroup (e.g., TNBC, HR-positive/HER2-negative, number of prior lines of therapy), outcome definitions, and timepoints at which outcomes were assessed.

Connected networks that included ERI and at least a subset of comparators for key efficacy and safety outcomes were identified and are presented in Figs. 1, ,2,2, ,3,3, ,4,4, ,5,5, ,6,6, ,7,7, ,8.8. Direct head-to-head efficacy and safety comparisons versus ERI were available for CAP and TPC, and other comparators were compared indirectly. Studies reporting treatment with VIN monotherapy, docetaxel (DOC) monotherapy, GEM+DOC, and CAP+DOC were identified by the SLR, but did not connect to the networks.

Network Diagram: Overall Survival (Base-case Analysis). Abbreviations: CAP = capecitabine; ERI = eribulin; GEM = gemcitabine; IXA = ixabepilone; TPC = treatment by physician’s choice; UTI = utidelone; VIN = vinorelbine

Network Diagram: Overall Survival (TNBC Subgroup Analysis). Abbreviations: CAP = capecitabine; ERI = eribulin; IXA = ixabepilone; TNBC = triple negative breast cancer; TPC = treatment by physician’s choice

Network Diagram: Overall Survival (HER2-negative Subgroup Analysis). Abbreviations: CAP = capecitabine; ERI = eribulin; GEM = gemcitabine; IXA = ixabepilone; TPC = treatment by physician’s choice; VIN = vinorelbine

Network Diagram: Progression-free Survival (Base-case Analysis). Abbreviations: CAP = capecitabine; ERI = eribulin; GEM = gemcitabine; IXA = ixabepilone; TPC = treatment by physician’s choice; UTI = utidelone; VIN = vinorelbine

Network Diagram: Progression-free Survival (TNBC Subgroup Analysis). Abbreviations: CAP = capecitabine; ERI = eribulin; IXA = ixabepilone; TNBC = triple negative breast cancer; TPC = treatment by physician’s choice

Network Diagram: Progression-free Survival (HER2-negative Subgroup Analysis). Abbreviations: CAP = capecitabine; ERI = eribulin; GEM = gemcitabine; IXA = ixabepilone; TPC = treatment by physician’s choice; VIN = vinorelbine

Network Diagram: Discontinuation due to AEs (Base-case Analysis). Abbreviations: AE = adverse event; CAP = capecitabine; ERI = eribulin; GEM = gemcitabine; IXA = ixabepilone; TPC = treatment by physician’s choice; UTI = utidelone; VIN = vinorelbine

Network Diagram: SAEs (Base-case Analysis). Abbreviations: CAP = capecitabine; ERI = eribulin; SAE = serious adverse event; TPC = treatment by physician’s choice; UTI = utidelone

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