PMID- 31588018
OWN - NLM
STAT- MEDLINE
DCOM- 20200720
LR  - 20220411
IS  - 2588-9311 (Electronic)
IS  - 2588-9311 (Linking)
VI  - 2
IP  - 6
DP  - 2019 Nov
TI  - First-line Treatment of Metastatic Renal Cell Carcinoma: A Systematic Review and 
      Network Meta-analysis.
PG  - 708-715
LID - S2588-9311(19)30143-9 [pii]
LID - 10.1016/j.euo.2019.09.002 [doi]
AB  - CONTEXT: No head-to-head clinical trials compare contemporary first-line 
      therapies for metastatic renal cell carcinoma (mRCC). A network meta-analysis 
      provides an approach for quantitative analysis. OBJECTIVE: To indirectly compare 
      the efficacy and safety of first-line treatments for mRCC in the 
      intention-to-treat (ITT) population and by clinical risk group. EVIDENCE 
      ACQUISITION: An updated systematic review from database inception to February 17, 
      2019 identified all parallel-group randomized controlled trials assessing 
      first-line therapy for mRCC. "Clinically relevant" studies were selected for a 
      network meta-analysis. Progression-free survival (PFS) was the primary outcome. 
      Overall survival (OS), overall response rate (ORR), and grade 3 and 4 adverse 
      events (AEs) were secondary outcomes. EVIDENCE SYNTHESIS: We identified 12 
      relevant trials: 12 reported outcomes for PFS, nine for OS, 10 for ORR, and nine 
      for AEs. In the ITT population, cabozantinib (surface under the cumulative 
      ranking curves [SUCRA] 84%), avelumab plus axitinib (SUCRA 68%), and 
      pembrolizumab plus axitinib (SUCRA 82%) were superior to the other agents for 
      PFS; pembrolizumab plus axitinib appeared superior for OS (SUCRA 95%); and 
      atezolizumab demonstrated the lowest likelihood of AEs (SUCRA 100%). Findings 
      were similar in the intermediate/poor-risk subgroup. Based on the limited data 
      available, avelumab plus axitinib may be preferred in patients with 
      favorable-risk disease. CONCLUSIONS: The optimal first-line treatment for mRCC 
      appears to differ by efficacy endpoint, toxicity, and clinical risk group. Direct 
      comparative studies remain important in guiding treatment choice. PATIENT 
      SUMMARY: Head-to-head comparisons do not exist for the newest treatments of 
      metastatic renal cell carcinoma (mRCC). In an indirect comparison, we found that 
      pembrolizumab plus axitinib and cabozantinib are good options for most patients 
      with mRCC.
CI  - Copyright (c) 2019. Published by Elsevier B.V.
FAU - Hahn, Andrew W
AU  - Hahn AW
AD  - Division of Oncology, Department of Internal Medicine, Huntsman Cancer Institute, 
      University of Utah, Salt Lake City, UT, USA.
FAU - Klaassen, Zachary
AU  - Klaassen Z
AD  - Division of Urology, Medical College of Georgia at Augusta University, Augusta, 
      GA, USA; Georgia Cancer Center, Augusta, GA, USA.
FAU - Agarwal, Neeraj
AU  - Agarwal N
AD  - Division of Oncology, Department of Internal Medicine, Huntsman Cancer Institute, 
      University of Utah, Salt Lake City, UT, USA.
FAU - Haaland, Benjamin
AU  - Haaland B
AD  - Division of Oncology, Department of Internal Medicine, Huntsman Cancer Institute, 
      University of Utah, Salt Lake City, UT, USA.
FAU - Esther, John
AU  - Esther J
AD  - Division of Oncology, Department of Internal Medicine, Huntsman Cancer Institute, 
      University of Utah, Salt Lake City, UT, USA.
FAU - Ye, Xiang Y
AU  - Ye XY
AD  - MiCare Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.
FAU - Wang, Xuechen
AU  - Wang X
AD  - Division of Oncology, Department of Internal Medicine, Huntsman Cancer Institute, 
      University of Utah, Salt Lake City, UT, USA.
FAU - Pal, Sumanta K
AU  - Pal SK
AD  - Department of Medical Oncology and Therapeutics Research, City of Hope 
      Comprehensive Cancer Center, Duarte, CA, USA.
FAU - Wallis, Christopher J D
AU  - Wallis CJD
AD  - Division of Urology, Department of Surgery, University of Toronto, Toronto, 
      Ontario, Canada.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20191004
PL  - Netherlands
TA  - Eur Urol Oncol
JT  - European urology oncology
JID - 101724904
SB  - IM
MH  - Carcinoma, Renal Cell/pathology/*therapy
MH  - Humans
MH  - Neoplasm Metastasis
MH  - Progression-Free Survival
OTO - NOTNLM
OT  - Avelumab
OT  - First line
OT  - International Metastatic Renal Cell Carcinoma Database Consortium
OT  - Memorial Sloan Kettering Cancer Center
OT  - Metastatic renal cell carcinoma
OT  - Network meta-analysis
OT  - Pembrolizumab
EDAT- 2019/10/08 06:00
MHDA- 2020/07/21 06:00
CRDT- 2019/10/08 06:00
PHST- 2019/07/07 00:00 [received]
PHST- 2019/09/09 00:00 [accepted]
PHST- 2019/10/08 06:00 [pubmed]
PHST- 2020/07/21 06:00 [medline]
PHST- 2019/10/08 06:00 [entrez]
AID - S2588-9311(19)30143-9 [pii]
AID - 10.1016/j.euo.2019.09.002 [doi]
PST - ppublish
SO  - Eur Urol Oncol. 2019 Nov;2(6):708-715. doi: 10.1016/j.euo.2019.09.002. Epub 2019 
      Oct 4.