Analytica LA-SER Intl. Inc, Chester Platz 1, 79539, Lörrach, Germany.
IPSEN Pharma SAS, Boulogne-Billancourt Cedex, France.
Target Oncol. 2018 Apr;13(2):205-216. doi: 10.1007/s11523-018-0559-0.
Cabozantinib has recently been evaluated as a first-line treatment in advanced renal cell carcinoma (aRCC).
To indirectly assess efficacy of cabozantinib versus standard-of-care (SoC) comparators in the first-line treatment of aRCC.
We conducted a systematic literature review (SLR) to identify randomized controlled studies in the first-line setting for aRCC. The outcomes analyzed were overall survival (OS) and progression-free survival (PFS). A network meta-analysis (NMA) was conducted comparing OS and PFS hazard ratios (HRs).
Thirteen studies were identified in the SLR to be eligible for inclusion in the NMA. The overall study populations were heterogeneous in terms of risk groups; some studies included favorable risk patients. In intermediate-risk patients, HRs (95% confidence interval) for PFS were 0.52 (0.33, 0.82), 0.46 (0.26, 0.80), 0.20 (0.12, 0.36), and 0.37 (0.20, 0.68) when cabozantinib was compared with sunitinib, sorafenib, interferon (IFN), or bevacizumab plus IFN, respectively. In poor-risk patients, the NMA also demonstrated significant superiority in terms of PFS for cabozantinib; HRs were 0.31 (0.11, 0.90), 0.22 (0.06, 0.87), 0.16 (0.04, 0.64), and 0.20 (0.05, 0.88), when cabozantinib was compared with sunitinib, temsirolimus, IFN, or bevacizumab plus IFN, respectively. When the overall study populations were compared, the results were similar to the subgroup analyses. OS HRs in all analyses favored cabozantinib, but were not statistically significant.
The results suggest that cabozantinib significantly increases PFS in intermediate-, and poor-risk subgroups when compared to standard-of-care comparators. Although overall populations included favorable risk patients in some studies, the results seen were consistent with the subgroup analyses.
卡博替尼最近被评估为晚期肾细胞癌（aRCC）的一线治疗药物。
间接评估卡博替尼与 aRCC 一线治疗标准护理（SoC）对照药物相比的疗效。
我们进行了系统文献综述（SLR），以确定 aRCC 一线治疗的随机对照研究。分析的结局是总生存期（OS）和无进展生存期（PFS）。进行了网络荟萃分析（NMA），比较 OS 和 PFS 风险比（HR）。
SLR 中确定了 13 项符合纳入 NMA 标准的研究。总体研究人群在风险组方面存在异质性；一些研究纳入了低危患者。在中危患者中，卡博替尼与舒尼替尼、索拉非尼、干扰素（IFN）或贝伐珠单抗加 IFN 相比，PFS 的 HR 分别为 0.52（0.33，0.82）、0.46（0.26，0.80）、0.20（0.12，0.36）和 0.37（0.20，0.68）。在高危患者中，NMA 也表明卡博替尼在 PFS 方面具有显著优势；卡博替尼与舒尼替尼、替西罗莫司、IFN 或贝伐珠单抗加 IFN 相比，HR 分别为 0.31（0.11，0.90）、0.22（0.06，0.87）、0.16（0.04，0.64）和 0.20（0.05，0.88）。当比较所有研究人群时，结果与亚组分析相似。所有分析的 OS HR 均有利于卡博替尼，但无统计学意义。
结果表明，与标准护理对照药物相比，卡博替尼可显著增加中危和高危亚组的 PFS。尽管一些研究的总体人群包括低危患者，但观察到的结果与亚组分析一致。
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