Abstract
The network meta-analysis was conducted to compare the short-term efficacy of different single-drug targeted therapies in the treatment of renal cell carcinoma (RCC). We initially searched databases for randomized controlled trials (RCTs) on different single-drug targeted therapies in treating RCC. The meta-analysis combined the direct and indirect evidence to calculate the pooled odds ratios (OR) and draw surface under the cumulative ranking curves (SUCRA). A total of 14 eligible RCTs were ultimately selected. The partial response (PR) of Cabozantinib in the treatment of RCC was better than Sunitinib (OR = 2.7, 95%CI = 1.0–7.8), Everolimus (OR = 8.1, 95%CI = 3.1–25.0), and Temsirolimus (OR = 4.8, 95%CI = 1.0–31.0); the overall response rate (ORR) of Cabozantinib was better than Sorafenib, Sunitinib, Everolimus, and Temsirolimus (OR = 5.5, 95%CI = 1.1–27.0; OR = 2.6, 95%CI = 1.1–6.6; OR = 8.3, 95%CI = 3.5–20.0; OR = 5.7, 95%CI = 1.3–28.0 respectively). In addition, as for complete response (CR), PR, stable disease (SD), progressive disease (PD), ORR, and disease control rate (DCR), Cabozantinib had the best short-term efficacy among nine single-drug targeted therapies in the treatment of RCC (CR: 50.3%; PR: 93.6%; SD: 75.1%; PD: 68.0%; ORR: 95.5%; DCR: 73.2%); while Everolimus had the worst short-term efficacy (CR: 33.6%; PR: 22.3%; SD: 78.0%; PD: 35.9%; ORR: 22.9%; DCR: 19.9%). Our network meta-analysis indicated that Cabozantinib might have better short-term efficacy than other regimens in the treatment of RCC, while Everolimus might have poor short-term efficacy.
Highlights
Malignant renal cell carcinoma (RCC) accounts for 2–3% of cancer incidence and results in more than 100,000 deaths worldwide every year [1]
The inclusion criteria were as follows: (1) study design must be randomized controlled trials (RCTs); (2) studies investigated the efficacy of Sorafenib, Sunitinib, Everolimus, Temsirolimus, Axitinib, Tivozanib, Dovitinib, Pazopanib, and Cabozantinib in the treatment of RCC; (3) study subjects should be patients with RCC aging from 17 to 89 years; (4) the end outcomes of studies should include complete response (CR), partial response (PR), overall response rate (ORR), progressive disease (PD), stable disease (SD), and disease control rate (DCR)
The ORR, CR, PR, SD, PD, and DCR outcomes were analyzed by inconsistency tests with the node-splitting method, and the analysis indicated that all outcomes of the direct and indirect evidence were consistent, the consistency model should be adopted (Figures 3 and 4)
Summary
Malignant renal cell carcinoma (RCC) accounts for 2–3% of cancer incidence and results in more than 100,000 deaths worldwide every year [1]. Local recurrence or distant metastasis occurs in up to 40% of patients treated for localized tumors and 5-year survival is less than 10% in this subgroup RCC, which accounts for 80–90% of kidney cancers and 70–80% of these are clear cell RCC [3,4]. Tumors have been used to treat with cytokines with modest response rates (RR) and small survival benefit [5]. Mutations in the c 2017 The Author(s).
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