Department of Urology.
Center for Data Solutions, University of Florida, Jacksonville, FL.
Am J Clin Oncol. 2020 Jul;43(7):477-483. doi: 10.1097/COC.0000000000000695.
Randomized clinical trials have shown combination therapy to be superior in progression-free survival (PFS) rates when compared with sunitinib alone. However, there have been no direct comparisons among the combination strategies making it unclear as to which may be the preferred option. We performed a network meta-analysis of the combination therapy (immune checkpoint inhibitor plus axitinib or bevacizumab) used in metastatic renal cell carcinoma (mRCC) and provided a rank order preference based on PFS, and adverse events (AEs).
A systematic search on the treatment of mRCC using combination therapy till July 2019 was done. Studies reporting on combination therapies with immune checkpoint inhibitor plus axitinib or bevacizumab for mRCC were selected. Frequentist method was used for rank order generation.
A total of 3 studies consisting of 2672 patients were selected. All combination therapies demonstrated improved PFS when compared with sunitinib alone. The rank order for PFS showed combination of pembrolizumab plus axitinib had the highest probability of favorability followed by avelumab plus axitinib and atezolizumab plus bevacizumab (surface under the cumulative ranking 0.9, 0.7, and 0.4, respectively). For AEs, pembrolizumab plus axitinib had the least AEs ≥grade 3, followed by avelumab plus axitinib and atezolizumab plus bevacizumab (surface under the cumulative ranking 0, 0.5, 1.0).
This network meta-analysis demonstrates that combination of pembrolizumab plus axitinib may be the preferred option based on efficacy and side effect profile compared with avelumab plus axitinib or atezolizumab plus bevacizumab. However, all the 3 combination strategies were superior to sunitinib alone in improving PFS in patients with mRCC.
随机临床试验表明，与单独使用舒尼替尼相比，联合治疗在无进展生存期（PFS）方面更具优势。然而，由于没有对这些联合治疗策略进行直接比较，因此尚不清楚哪种方法可能是首选。我们对转移性肾细胞癌（mRCC）中使用的联合治疗（免疫检查点抑制剂加阿昔替尼或贝伐珠单抗）进行了网络荟萃分析，并根据 PFS 和不良事件（AE）提供了排序偏好。
对截至 2019 年 7 月使用联合治疗治疗 mRCC 的治疗方法进行了系统检索。选择报告免疫检查点抑制剂加阿昔替尼或贝伐珠单抗联合治疗 mRCC 的研究。使用频率论方法生成排序。
共纳入 3 项研究，共 2672 例患者。与单独使用舒尼替尼相比，所有联合治疗均能改善 PFS。PFS 的排序显示，帕博利珠单抗加阿昔替尼联合治疗具有最高的有利概率，其次是avelumab 加阿昔替尼和阿特珠单抗加贝伐珠单抗（累积排序表面 0.9、0.7 和 0.4）。对于 AE，pembrolizumab 加 axitinib 的≥3 级 AE 最少，其次是avelumab 加 axitinib 和 atezolizumab 加 bevacizumab（累积排序表面 0、0.5、1.0）。
这项网络荟萃分析表明，与avelumab 加 axitinib 或 atezolizumab 加 bevacizumab 相比，pembrolizumab 加 axitinib 的联合治疗可能是基于疗效和副作用特征的首选方案。然而，所有 3 种联合治疗策略在改善 mRCC 患者的 PFS 方面均优于单独使用舒尼替尼。
