PMID- 33338727
OWN - NLM
STAT- MEDLINE
DCOM- 20210917
LR  - 20210917
IS  - 1879-0852 (Electronic)
IS  - 0959-8049 (Linking)
VI  - 144
DP  - 2021 Feb
TI  - Comparative efficacy and tolerability of third-line treatments for advanced 
      gastric cancer: A systematic review with Bayesian network meta-analysis.
PG  - 49-60
LID - S0959-8049(20)31317-4 [pii]
LID - 10.1016/j.ejca.2020.10.030 [doi]
AB  - BACKGROUND: The most effective agent for the third-line treatment of 
      advanced/metastatic gastric cancer (AGC) has not yet been determined. The aim of 
      this network meta-analysis is to compare the relative efficacy and tolerability 
      of third-line treatments for AGC. MATERIALS AND METHODS: We conducted a 
      comprehensive literature review of randomised clinical trials (RCTs) using four 
      electronic databases. Overall survival (OS), progression-free survival (PFS), 
      objective response rate (ORR) and adverse events (AEs) were used as efficacy or 
      tolerability outcomes. A Bayesian network meta-analysis with a random-effects 
      model was used. RESULTS: Seven RCTs involving 2601 patients and nine treatments 
      were included. The results suggested that 1 mg/kg nivolumab 
      (nivolumab1) + 3 mg/kg ipilimumab (ipilimumab3) (hazard ratio [HR] 0.59, 95% 
      credible interval [Crl] 0.38-0.91) was the most effective treatment, followed by 
      nivolumab (HR 0.63, 95% Crl 0.50-0.79), for prolonging OS. Regorafenib (HR 0.40, 
      95% Crl 0.28-0.58) was most likely to improve PFS, followed by apatinib (HR 0.45, 
      95% Crl 0.33-0.60). Nivolumab1 + ipilimumab3 and nivolumab were better at 
      improving ORR, whereas nivolumab1 + ipilimumab3 had the highest toxicity based on 
      the AEs. For benefit-risk ratio, nivolumab, apatinib or regorafenib appeared to 
      be the best options. Chemotherapy or two different dose combinations of nivolumab 
      and ipilimumab were ranked as the next options because of poor tolerability, 
      despite good efficacy. CONCLUSION: Immunotherapy (nivolumab) or antiangiogenic 
      agents (regorafenib and apatinib) are associated with benefits for benefit-risk 
      ratio as third-line monotherapy. This study might serve as a guideline to aid in 
      the selection of third-line treatments for AGC.
CI  - Copyright (c) 2020 Elsevier Ltd. All rights reserved.
FAU - Park, Sejung
AU  - Park S
AD  - Department of Biostatistics and Computing, Yonsei University College of Medicine, 
      Seoul, South Korea; Songdang Institute for Cancer Research, Yonsei University 
      College of Medicine, Seoul, South Korea. Electronic address: SEUPARK@yuhs.ac.
FAU - Nam, Chung Mo
AU  - Nam CM
AD  - Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, 
      South Korea. Electronic address: CMNAM@yuhs.ac.
FAU - Kim, Seul-Gi
AU  - Kim SG
AD  - Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer 
      Center, Yonsei University College of Medicine, Seoul, South Korea. Electronic 
      address: SOPHIA311@yuhs.ac.
FAU - Mun, Ji Eun
AU  - Mun JE
AD  - Department of Biostatistics and Computing, Yonsei University College of Medicine, 
      Seoul, South Korea. Electronic address: MUNJE622@yuhs.ac.
FAU - Rha, Sun Young
AU  - Rha SY
AD  - Songdang Institute for Cancer Research, Yonsei University College of Medicine, 
      Seoul, South Korea; Division of Medical Oncology, Department of Internal 
      Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, 
      South Korea; Brain Korea 21 PLUS Project for Medical Sciences, Yonsei University 
      College of Medicine, Seoul, South Korea. Electronic address: RHA7655@yuhs.ac.
FAU - Chung, Hyun Cheol
AU  - Chung HC
AD  - Songdang Institute for Cancer Research, Yonsei University College of Medicine, 
      Seoul, South Korea; Division of Medical Oncology, Department of Internal 
      Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, 
      South Korea. Electronic address: UNCHUNG8@yuhs.ac.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Systematic Review
DEP - 20201215
PL  - England
TA  - Eur J Cancer
JT  - European journal of cancer (Oxford, England : 1990)
JID - 9005373
SB  - IM
MH  - Antineoplastic Combined Chemotherapy Protocols/*therapeutic use
MH  - *Bayes Theorem
MH  - Humans
MH  - Maximum Tolerated Dose
MH  - *Network Meta-Analysis
MH  - Stomach Neoplasms/*drug therapy/pathology
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Advanced gastric cancer
OT  - Antiangiogenic agents
OT  - Bayesian analysis
OT  - Immunotherapy
OT  - Network meta-analysis
OT  - Systematic review
OT  - Third-line treatments
COIS- Conflict of interest statement The authors have declared no conflicts of 
      interest.
EDAT- 2020/12/19 06:00
MHDA- 2021/09/18 06:00
CRDT- 2020/12/18 20:11
PHST- 2020/02/24 00:00 [received]
PHST- 2020/10/11 00:00 [revised]
PHST- 2020/10/20 00:00 [accepted]
PHST- 2020/12/19 06:00 [pubmed]
PHST- 2021/09/18 06:00 [medline]
PHST- 2020/12/18 20:11 [entrez]
AID - S0959-8049(20)31317-4 [pii]
AID - 10.1016/j.ejca.2020.10.030 [doi]
PST - ppublish
SO  - Eur J Cancer. 2021 Feb;144:49-60. doi: 10.1016/j.ejca.2020.10.030. Epub 2020 Dec 
      15.