Department of Urology, The Second Affiliated Hospital of Kunming Medical University, No.374, Dianmian Avenue, Yunnan, 650101, People's Republic of China.
BMC Urol. 2019 Dec 2;19(1):125. doi: 10.1186/s12894-019-0560-7.
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.
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).
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.
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.
如果铂类化疗后出现进展或失败，或者患者不适合顺铂，则对尿路上皮癌 (UC) 患者进行二线治疗。然而，目前仍然没有被广泛接受的治疗策略。我们旨在分析 UC 患者二线治疗策略的有效性和安全性。
我们检索了 PubMed、Embase 和 Cochrane 数据库中截至 2019 年 4 月 19 日的随机对照试验 (RCT)，其中包括不适合或不适合顺铂的 UC 患者。主要结局是无进展生存期 (PFS)、总生存期 (OS) 和客观缓解率 (ORR)。
共纳入 13 项评估 3502 例 UC 患者的试验。本研究将网络比较分为三部分。第一部分包含比较紫杉烷和其他干预措施的研究；第二部分评估了研究者选择化疗 (ICC) 相关比较；第三部分评估了最佳支持治疗 (BSC)。在第一部分的 OS 结果中，帕博利珠单抗 (87.5%)、雷莫芦单抗联合多西他赛 (74.6%) 和阿替利珠单抗 (71.1%) 具有相对优势。帕博利珠单抗在 ORR 和严重不良事件 (SAE) 结果方面也具有优势。探索性聚类分析显示，长春氟宁和雷莫芦单抗联合多西他赛的累积排序曲线下面积 (SUCRA) 排名相对较高。
本研究得出结论，阿替利珠单抗和帕博利珠单抗优于其他治疗方法，主要在 OS 结果方面，但在 PFS 方面没有任何治疗方法具有显著优势。与 ICC 相比，帕博利珠单抗在 ORR 和 SAE 结果方面仍具有相对优势。由于存在局限性，需要更多的研究来证实这些结论。
