Hoang Tung, Myung Seung-Kwon, Pham Thu Thi, Kim Jeongseon, Ju Woong
Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang 10408, Korea.
Division of Cancer Epidemiology and Management, National Cancer Center Research Institute, Goyang 10408, Korea.
J Clin Med. 2020 Apr 9;9(4):1063. doi: 10.3390/jcm9041063.
This study aims to investigate the efficacy of targeted therapies in the treatment of non-small cell lung cancer (NSCLC) by using a network meta-analysis of clinical trials. PubMed, EMBASE, Cochrane Library, and Clinicaltrials.gov were searched by using keywords related to the topic on 19 September 2018. Two investigators independently selected relevant trials by pre-determined criteria. A pooled response ratio (RR) for overall response rate (ORR) and a hazard ratio (HR) for progression-free survival (PFS) were calculated based on both the Bayesian and frequentist approaches. A total of 128 clinical trials with 39,501 participants were included in the final analysis of 14 therapeutic groups. Compared with chemotherapy, both ORR and PFS were significantly improved for afatinib, alectinib, and crizotinib, while only PFS was significantly improved for cabozantinib, ceritinib, gefitinib, and osimertinib. Consistency was observed between the direct and indirect comparisons based on the Bayesian approach statistically and the frequentist approach visually. Cabozantinib and alectinib showed the highest probability for the first-line treatment ranking in ORR (62.5%) and PFS (87.5%), respectively. The current network meta-analysis showed the comprehensive evidence-based comparative efficacy of different types of targeted therapies, which would help clinicians use targeted therapies in clinical practice.
本研究旨在通过对临床试验进行网络荟萃分析，探讨靶向治疗在非小细胞肺癌（NSCLC）治疗中的疗效。2018年9月19日，使用与该主题相关的关键词在PubMed、EMBASE、Cochrane图书馆和Clinicaltrials.gov中进行检索。两名研究人员根据预先确定的标准独立选择相关试验。基于贝叶斯方法和频率学派方法，计算了总缓解率（ORR）的合并反应比（RR）和无进展生存期（PFS）的风险比（HR）。最终对14个治疗组的分析纳入了128项临床试验，共39501名参与者。与化疗相比，阿法替尼、阿来替尼和克唑替尼的ORR和PFS均显著改善，而卡博替尼、色瑞替尼、吉非替尼和奥希替尼仅PFS显著改善。基于贝叶斯方法的直接和间接比较在统计学上具有一致性，基于频率学派方法的直接和间接比较在视觉上具有一致性。卡博替尼和阿来替尼在ORR（62.5%）和PFS（87.5%）的一线治疗排名中显示出最高概率。当前的网络荟萃分析显示了不同类型靶向治疗基于证据的综合比较疗效，这将有助于临床医生在临床实践中使用靶向治疗。
