Comparative efficacy and tolerability of third-line treatments for advanced gastric cancer: A systematic review with Bayesian network meta-analysis
| Autor: | Seul-Gi Kim, Sejung Park, Ji Eun Mun, Sun Young Rha, Chung Mo Nam, Hyun Cheol Chung |
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| Rok vydání: | 2021 |
| Předmět: |
0301 basic medicine
Oncology Cancer Research medicine.medical_specialty Maximum Tolerated Dose Network Meta-Analysis Ipilimumab 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Stomach Neoplasms Internal medicine Regorafenib Antineoplastic Combined Chemotherapy Protocols medicine Humans Apatinib Adverse effect business.industry Hazard ratio Bayes Theorem Clinical trial Treatment Outcome 030104 developmental biology Tolerability chemistry 030220 oncology & carcinogenesis Nivolumab business medicine.drug |
| Zdroj: | European Journal of Cancer. 144:49-60 |
| ISSN: | 0959-8049 |
| DOI: | 10.1016/j.ejca.2020.10.030 |
| Popis: | Background The most effective agent for the third-line treatment of advanced/metastatic gastric cancer (AGC) has not yet been determined. The aim of this network meta-analysis is to compare the relative efficacy and tolerability of third-line treatments for AGC. Materials and methods We conducted a comprehensive literature review of randomised clinical trials (RCTs) using four electronic databases. Overall survival (OS), progression-free survival (PFS), objective response rate (ORR) and adverse events (AEs) were used as efficacy or tolerability outcomes. A Bayesian network meta-analysis with a random-effects model was used. Results Seven RCTs involving 2601 patients and nine treatments were included. The results suggested that 1 mg/kg nivolumab (nivolumab1) + 3 mg/kg ipilimumab (ipilimumab3) (hazard ratio [HR] 0.59, 95% credible interval [Crl] 0.38–0.91) was the most effective treatment, followed by nivolumab (HR 0.63, 95% Crl 0.50–0.79), for prolonging OS. Regorafenib (HR 0.40, 95% Crl 0.28–0.58) was most likely to improve PFS, followed by apatinib (HR 0.45, 95% Crl 0.33–0.60). Nivolumab1 + ipilimumab3 and nivolumab were better at improving ORR, whereas nivolumab1 + ipilimumab3 had the highest toxicity based on the AEs. For benefit-risk ratio, nivolumab, apatinib or regorafenib appeared to be the best options. Chemotherapy or two different dose combinations of nivolumab and ipilimumab were ranked as the next options because of poor tolerability, despite good efficacy. Conclusion Immunotherapy (nivolumab) or antiangiogenic agents (regorafenib and apatinib) are associated with benefits for benefit-risk ratio as third-line monotherapy. This study might serve as a guideline to aid in the selection of third-line treatments for AGC. |
| Databáze: | OpenAIRE |
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