Pan Wen-Tao, Zhou Su-Na, Pan Meng-Xian, Luo Qiu-Yun, Zhang Lin, Yang Da-Jun, Qiu Miaozhen
State Key Laboratory of Oncology in South China, Department of Experimental Research, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.
State Key Laboratory of Oncology in South China, Department of Clinical Laboratory, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.
Front Oncol. 2020 Apr 23;10:513. doi: 10.3389/fonc.2020.00513. eCollection 2020.
Increasing evidences from phase II or III trials have proved that salvage systematic therapy, including chemotherapy, target therapy, or checkpoint inhibitor therapy can prolong survival in patients who do not succeed with second line therapy, yet there are no guidelines for the optimum third-line treatments. To compare the effectiveness and safety of current third-line therapies for metastatic Gastric Cancer (mGC), we conducted this network analysis. Literature up to Sep 30, 2019 were systematically searched and analyzed by a Bayesian fixed-effect model. This study included seven randomized clinical trails which involved 2,655 patients. It turns out that for overall survival, nivolumab has the highest probability to be the optimal choice for overall survival (OS). For patients with no peritoneal metastases, the network meta-analysis showed that Nivolumab (HR:0.64; 95% CI: 0.48-0.85) and Trifluridine/tipiacil (HR:0.66; 95% CI: 0.51-0.86) were associated with significantly higher improvement in OS than placebo. However, patients with peritoneal metastases could not benefit from nivolumab, ramucirumab, or Trifluridine/tipiacil, when compared with a placebo. For progression-free survival, apatinib (850 mg) was the most likely candidate, followed by ramucirumab. Statistically, Apatinib (850 mg), Trifluridine/tipiacil, and SLC had higher incidences of high-grade adverse events (AEs) than placebo. Our findings demonstrate that nivolumab has the best balance between acceptability and effectiveness in the third line therapy for mGC.
越来越多来自II期或III期试验的证据表明，挽救性全身治疗，包括化疗、靶向治疗或检查点抑制剂治疗，可以延长二线治疗未成功患者的生存期，但目前尚无关于最佳三线治疗的指南。为了比较目前转移性胃癌（mGC）三线治疗的有效性和安全性，我们进行了这项网络分析。通过贝叶斯固定效应模型对截至2019年9月30日的文献进行了系统检索和分析。本研究纳入了7项随机临床试验，涉及2655例患者。结果表明，在总生存期方面，纳武单抗最有可能成为总生存期（OS）的最佳选择。对于无腹膜转移的患者，网络荟萃分析显示，纳武单抗（HR：0.64；95%CI：0.48-0.85）和曲氟尿苷/替匹嘧啶（HR：0.66；95%CI：0.51-0.86）与OS的显著改善相关，优于安慰剂。然而，与安慰剂相比，有腹膜转移的患者无法从纳武单抗、雷莫西尤单抗或曲氟尿苷/替匹嘧啶中获益。在无进展生存期方面，阿帕替尼（850mg）是最有可能的选择，其次是雷莫西尤单抗。统计学上，阿帕替尼（850mg）、曲氟尿苷/替匹嘧啶和SLC的高级别不良事件（AE）发生率高于安慰剂。我们的研究结果表明，在mGC的三线治疗中，纳武单抗在可接受性和有效性之间具有最佳平衡。
