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First-Line Systemic Treatments for Advanced/Metastatic Renal Cell Carcinoma of Favorable-, Intermediate-, and Poor-Risk, Respectively: A Bayesian Network Analysis

36 Pages Posted: 28 Jan 2019

See all articles by Junpeng Wang

Junpeng Wang

Zhengzhou University

Xin Li

Zhengzhou University

Zhiwei Wang

Zhengzhou University

Jianhua Hou

Jilin University (JLU)

Lei Yang

Jilin University (JLU)

Peiyan Zhao

Jilin University (JLU)

Zhenya Li

Zhengzhou University - Zhengzhou Central Hospital

Xiaoqiang Wu

Zhengzhou University - Department of Urology

Tianzhong Yan

Zhengzhou University - Department of Urology

More...

Abstract

Background: Advanced/metastatic renal cell carcinoma (RCC) is a heterogeneous group of conditions with different risk stratification. The optimum systemic therapies for advanced/metastatic RCC of favorable-, intermediate-, and poor-risk have not been established. We aimed to compare and rank the effects associated with systemic therapies in the first-line setting.  

Methods: We searched Pubmed, Cochrane databases, Web of Science, and ClinicalTrials.gov for randomized controlled trials (RCTs) published up to October 2018, of systemic therapies for advanced/metastatic RCC. Analysis was done on a Bayesian framework.  

Findings: 13 unique RCTs including 7 248 patients were identified. For favorable-risk patients, temsirolimus plus bevacizumab, and nivolumab plus ipilimumab were associated with significantly worse progression-free survival (PFS) than sunitinib (HR 1.96, 95% CI 1.04-3.63; and HR 1.56, 95% CI 1.32-1.84, respectively). For intermediate-risk patients, nivolumab plus ipilimumab and cabozantinib were associated with significantly higher improvement in PFS than sunitinib (HR 0.66, 95% CI 0.54-0.81; HR 0.64, 95% CI 0.43-0.96, respectively). For poor-risk, nivolumab plus ipilimumab provided obvious PFS advantage over sunitinib (HR 0.57; 95% CI 0.4-0.70). For PFS, there was a 41.7% likelihood that sunitinib was the preferred treatment for favorable-risk patients. There was a 38.3% likelihood that cabozantinib was the preferred option for intermediate-risk patients. There was a 67.7% chance that nivolumab plus ipilimumab was the best therapy for poor-risk patients. There were no significant differences in the rate of drug-related adverse events.  

Interpretation: Sunitinib, cabozantinib, and nivolumab plus ipilimumab might be the optimum treatments for advanced/metastatic RCC of favorable-, intermediate-, and poor-risk, respectively.

Funding Statement: The authors declare: "No Funding."

Declaration of Interests: The authors state: "None declared."

Ethics Approval Statement: All studies were selected compling with the search strategy on the basis of Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria. (PRISMA)

Keywords: renal cell carcinoma; systemic therapy; risk stratification; efficacy; safety

Suggested Citation

Wang, Junpeng and Li, Xin and Wang, Zhiwei and Hou, Jianhua and Yang, Lei and Zhao, Peiyan and Li, Zhenya and Wu, Xiaoqiang and Yan, Tianzhong, First-Line Systemic Treatments for Advanced/Metastatic Renal Cell Carcinoma of Favorable-, Intermediate-, and Poor-Risk, Respectively: A Bayesian Network Analysis (January 21, 2019). Available at SSRN: https://ssrn.com/abstract=3321478 or http://dx.doi.org/10.2139/ssrn.3321478

Junpeng Wang

Zhengzhou University

100 Science Avenue
Zhengzhou, Henan 450001
China

Xin Li

Zhengzhou University

100 Science Avenue
Zhengzhou, Henan 450001
China

Zhiwei Wang

Zhengzhou University

100 Science Avenue
Zhengzhou, Henan 450001
China

Jianhua Hou

Jilin University (JLU)

Guilin Road
Chaoyang, Changchun 130021
China

Lei Yang

Jilin University (JLU)

Guilin Road
Chaoyang, Changchun 130021
China

Peiyan Zhao

Jilin University (JLU)

Guilin Road
Chaoyang, Changchun 130021
China

Zhenya Li

Zhengzhou University - Zhengzhou Central Hospital

100 Science Avenue
Zhengzhou, Henan 45001
Cambodia

Xiaoqiang Wu

Zhengzhou University - Department of Urology ( email )

Zhengzhou, 450003
China

Tianzhong Yan (Contact Author)

Zhengzhou University - Department of Urology ( email )

Zhengzhou, 450003
China

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