Second-line treatment strategy for urothelial cancer patients who progress or are unfit for cisplatin therapy: a network meta-analysis.

Abstract

BACKGROUND:

Second-line treatment for urothelial carcinoma (UC) patients is used if progression or failure after platinum-based chemotherapy occurs or if patients are cisplatin-unfit. However, there is still no widely accepted treatment strategy. We aimed to analyze the effectiveness and safety of second-line treatment strategies for UC patients.

METHODS:

The PubMed, Embase, and Cochrane databases were searched for randomized controlled trials (RCTs) that included UC patients who were cisplatin-ineligible or unfit up to April 19, 2019. The primary outcomes were progression-free survival (PFS), overall survival (OS), and objective response rate (ORR).

RESULTS:

Thirteen trials that assessed 3502 UC patients were included. This study divided the network comparisons into three parts. The first part contained studies comparing taxanes and other interventions; the second part assessed investigator's choice chemotherapy (ICC)-related comparisons; and the third part assessed best support care (BSC). In the OS results of the first part, pembrolizumab (87.5%), ramucirumab plus docetaxel (74.6%), and atezolizumab (71.1%) had a relative advantage. Pembrolizumab also had advantages in ORR and severe adverse effect (SAE) results. Vinflunine and ramucirumab plus docetaxel had a relatively high surface under the cumulative ranking curve (SUCRA) rank by exploratory cluster analysis.

CONCLUSIONS:

This study concluded that atezolizumab and pembrolizumab are superior to other treatments, mainly in OS results, but no treatment confers a significant advantage in PFS. Pembrolizumab still has relative advantages in ORR and SAE results compared to ICC. Due to limitations, more studies are necessary to confirm the conclusions.

• Authors: Huitao Wang, Jianhe Liu, Kewei Fang, Changxing Ke, Yongming Jiang, Guang Wang, Tongxin Yang, Tao Chen, Xin Shi
• Journal: BMC urology (BMC Urol) Vol. 19 Issue 1 Pg. 125 (Dec 02 2019) ISSN: 1471-2490 [Electronic] England
• PMID: 31791304 (Publication Type: Journal Article, Meta-Analysis)

Chemical References

• Antineoplastic Agents
• Cisplatin

Topics

• Antineoplastic Agents (adverse effects)
• Carcinoma, Transitional Cell (drug therapy, therapy)
• Cisplatin (adverse effects)
• Humans
• Immunotherapy
• Network Meta-Analysis
• Randomized Controlled Trials as Topic