1. First-line antiangiogenics for metastatic renal cell carcinoma: A systematic review and network meta-analysis
- Author
-
Gaëlle Desamericq, Emilie Boissier, Stéphane Oudard, Cindy Neuzillet, Benoit Rousseau, Laurent Salomon, Helene Boussion, Emmanuelle Kempf, Christophe Tournigand, Isabelle Macquin-Mavier, Marie Chaubet-Houdu, Carolina Saldana, Alexandre de la Taille, and Charlotte Joly
- Subjects
Sorafenib ,Oncology ,medicine.medical_specialty ,Bevacizumab ,Angiogenesis Inhibitors ,urologic and male genital diseases ,law.invention ,Pazopanib ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Risk Factors ,Renal cell carcinoma ,law ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Carcinoma, Renal Cell ,Randomized Controlled Trials as Topic ,business.industry ,Sunitinib ,Hematology ,medicine.disease ,Kidney Neoplasms ,Surgery ,Axitinib ,Treatment Outcome ,030220 oncology & carcinogenesis ,Meta-analysis ,Disease Progression ,business ,medicine.drug - Abstract
Background Sunitinib, pazopanib, sorafenib, axitinib and bevacizumab are the five recommended antiangiogenic agents in first-line therapy for metastatic renal cell carcinoma (mRCC). Because these drugs underwent simultaneous clinical development, no direct efficacy and safety comparison was ever conducted, thus preventing optimal therapy choices. Methods We performed a traditional and network meta-analysis to evaluate the efficacy and safety of mRCC-recommended first-line antiangiogenic agents. After a systematic review of Medline and Embase up to July 2014, we identified randomized clinical trials (RCTs) evaluating the outcomes of mRCC patients treated with sunitinib, pazopanib, sorafenib, axitinib and bevacizumab as first-line treatment. Endpoints of interest were response rate, progression-free survival (PFS), overall survival (OS), and safety. Results We screened 769 abstracts and included nine RCTs with a total of 4282 patients. In the weighted pooled analysis, first-line antiangiogenic agents showed significant improvement in PFS (HR = 0.6; 95% IC, 0.51–0.72) and OS (HR = 0.85; 95% IC, 0.78–0.93) compared to control (placebo or interferon-alpha2a (INF)). Network meta-analysis showed no significant differences among antiangiogenic drugs in 6-month PFS, 1-year OS, disease control rate and drug-related safety for all-grade hypertension, diarrhea, weight-loss, nausea or anorexia. However, pazopanib showed a lower incidence of fatigue, anemia and hand foot skin reaction. Conclusions This meta-analysis confirms the benefits of first-line antiangiogenic therapy in mRCC, with an improvement in OS. Sunitinib, pazopanib, axitinib and bevacizumab + INF offer similar efficacy but different safety profiles which can help clinicians to better personalize treatment decisions in patients with mRCC.
- Published
- 2016