1. Correlation between ALK+ non-small cell lung cancer targeted therapy and thrombosis: a systematic review and network meta-analysis.
- Author
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Qi Y, Wang X, Guo T, You T, and Wang P
- Subjects
- Humans, Antineoplastic Agents administration & dosage, Antineoplastic Agents adverse effects, Bayes Theorem, Crown Ethers administration & dosage, Crown Ethers adverse effects, Molecular Targeted Therapy, Network Meta-Analysis, Organophosphorus Compounds administration & dosage, Organophosphorus Compounds adverse effects, Piperidines administration & dosage, Piperidines adverse effects, Pyrimidines administration & dosage, Pyrimidines adverse effects, Randomized Controlled Trials as Topic, Sulfones, Anaplastic Lymphoma Kinase antagonists & inhibitors, Carcinoma, Non-Small-Cell Lung drug therapy, Crizotinib administration & dosage, Crizotinib adverse effects, Lung Neoplasms drug therapy, Thrombosis chemically induced, Thrombosis epidemiology, Tyrosine Kinase Inhibitors administration & dosage, Tyrosine Kinase Inhibitors adverse effects
- Abstract
Objective: The main adjuvant therapies for anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer include ALK tyrosine kinase inhibitors (TKI) and chemotherapy. We aimed to compare differences in the incidence of thromboembolism (TE) among different treatment options., Design: Using a systematic review and Bayesian network meta-analysis (NMA)., Data Sources: We searched PubMed, Embase, Cochrane Library, ClinicalTrials.gov and Web of Science databases before 10 June 2023., Eligibility Criteria: We included published randomised controlled trials (RCT) involving comparisons of treatments between chemotherapy and ALK-TKI drugs., Data Extraction and Synthesis: Assessed risk bias with Cochrane tool. Conducted NMA with GEMTC in R, we evaluate the model fit using the deviation information criteria. Estimated posterior distribution using Markov Chain Monte Carlo, 4 chains, 10 fine-tuned iterations, 10 000 iterations per chain, total 50 000 iterations. Monitored potential scale reduction factor for convergence. And checked convergence with Gelman-Rubin statistics and trace plot. Provided surface under the cumulative ranking, lower values indicate less TE event probability., Results: Analysis of eight RCTs showed that, compared with that for crizotinib, there was a lower risk of total TE with chemotherapy (OR, 0.28; 95% credible intervals (CrI) 0.11 to 0.63), brigatinib (OR 0.31; 95% CrI 0.11 to 0.79) and ceritinib (OR 0.13; 95% CrI 0.03 to 0.45). In addition, analysis of venous TE (VTE) showed similar results, with a lower occurrence for chemotherapy (OR 0.27; 95% CrI 0.1 to 0.62), brigatinib (OR 0.18; 95% CrI 0.04 to 0.6) and ceritinib (OR 0.1; 95% CrI 0.02 to 0.43) compared with that for crizotinib. There were no significant differences in the occurrence of arterial TE among the different treatment options., Conclusion: Compared with chemotherapy, alectinib, lorlatinib, brigatinib and ceritinib, crizotinib significantly increased the risk of TE and VTE., Prospero Registration Number: CRD42023373307., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2024
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