Comparative efficacy and tolerability of antiemetic prophylaxis for adult highly emetogenic chemotherapy: A network meta‐analysis of 143 randomized controlled trials

Cheng, Ji; Cai, Ming; Shuai, Xiaoming; Gao, Jinbo; Wang, Guobin; Tao, Kaixiong

doi:10.1002/ijc.31125

Cited by 5 publications

(8 citation statements)

References 28 publications

(78 reference statements)

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“…21 This key feature reflected on and highlighted the two fundamental assumptions of network meta-analysis, known as transitivity and consistency. 22 When the head-to-head results of A versus C and B versus C were respectively provided, then the hypothesis of transitivity also validated a statistical comparison between A and B. However, it required comparable general features within each node as the prerequisite condition to eliminate selection bias and justify statistical connections among indirect arms.…”

Section: Discussionmentioning

confidence: 96%

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First-line systemic therapy for advanced gastric cancer: a systematic review and network meta-analysis

et al. 2019

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Background: Systemic therapy is the standard treatment against advanced gastric cancer. Fluoropyrimidine plus platinum doublet has been recommended as the preferred first-line strategy. However, there is still a lack of a comprehensive and hierarchical evidence that compares all eligible literature simultaneously. Methods: Record retrieval was conducted in PubMed, Web of Science, Cochrane Central Register of Controlled Trials, Embase, ASCO, and ESMO meeting library from inception to October 2018. Randomized controlled trials featuring comparisons between different first-line systemic treatments against advanced gastric cancer were eligible. Overall survival was utilized as the primary endpoint. Pairwise and network calculations were based on a random-effects model and the hierarchical ranking was numerically indicated by P-score. All procedures were conducted according to Cochrane Handbook 5.1 and PRISMA for Network Meta-analysis (Registration identifier: CRD42018084951). Results: A total of 119 studies were eligible for our pooled analysis. Concerning general analysis, ‘fluoropyrimidine plus platinum-based triplet’ topped the overall survival hierarchy (HR 0.91 [0.83–0.99], P-score = 0.903, p = 0.04) while it ranked in second place for progression-free survival and objective response rate. However, it displayed worse tolerability against ‘fluoropyrimidine plus platinum doublet’. More specifically, ‘Capecitabine plus cisplatin-based triplet plus targeted medication’ topped the ranking among all fluoropyrimidine plus platinum-based regimens in additional analysis. Nevertheless, it did not reach statistical advantage against fluoropyrimidine plus oxaliplatin doublet in terms of survival benefits, while still displaying significantly worse safety profile. Conclusions: Taken together, fluoropyrimidine plus oxaliplatin doublet (especially capecitabine or S-1) should still be considered as the preferred first-line regimen owing to its comparable survival benefits and lower toxicity.

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Section: Discussionmentioning

confidence: 96%

“…21 This key feature reflected on and highlighted the two fundamental assumptions of network meta-analysis, known as transitivity and consistency. 22…”

Section: Methodsmentioning

confidence: 99%

First-line systemic therapy for advanced gastric cancer: a systematic review and network meta-analysis

et al. 2019

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“…Inconsistency factor (IF) was the quantitative indicator for the loop-specific method, which hinted inconsistency once its 95% CI excluded zero. 15 Furthermore, the Q static of inconsistency was another indicator to estimate consistency across the network. Both consistency and homogeneity were fundamental requirements before producing reliable results by network meta-analysis.…”

Section: Discussionmentioning

confidence: 99%

“…It was well known that network meta-analysis could offer a hierarchical ranking among multiple arms despite lacking direct comparisons. 14,15 This vital advantage was based on two key assumptions of network meta-analysis that were known as transitivity and consistency, respectively. 15,16…”

Section: Methodsmentioning

confidence: 99%

Comparative efficacy and tolerability of adjuvant systemic treatments against resectable colon cancer: a network meta-analysis

et al. 2020

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Background: Currently, 6-month oxaliplatin-based chemotherapy has been recommended as the preferred adjuvant treatment against high-risk stage 2 and stage 3 colon cancer patients. Methods: Record retrieval was conducted in PubMed, Web of Science, Cochrane Central Register of Controlled Trials, American Society of Clinical Oncology and European Society for Medical Oncology meeting libraries from inception to November 2019. Regarding survival and tolerability, randomized controlled trials comparing different adjuvant systemic regimens against high-risk stage 2 and stage 3 colon cancer were eligible. Disease-free survival was primary endpoint. Network calculation was based on a random-effects model, and relative ranking of each node was numerically indicated by p score. Results: A total of 30 trials were included, corresponding to 54,109 patients. Regarding disease-free survival, none of the analyzed regimens displayed significant superiority against common comparator 6-month capecitabine plus oxaliplatin (XELOX), while 12-month [network hazard ratio (HR) 0.81 (0.60–1.10); 0.79 (0.57–1.10)] and 3-month XELOX [0.95 (0.86–1.04); 0.93 (0.83–1.05)] were top-ranking regimens showing non-inferiority among overall and stage 3 patients. Moreover, by pairwise meta-analysis, 3-month XELOX demonstrated significant superiority against 6-month XELOX among low-risk stage 3 patients [pairwise HR 0.78 (0.63–0.97)]. Concerning adverse events, 3-month oxaliplatin-based chemotherapy was significantly better than the 6-month counterpart with respect to peripheral sensory neuropathy, thrombocytopenia and fatigue. The 12-month capecitabine monotherapy failed to display non-inferiority among other major adverse events. Conclusions: The 3-month XELOX treatment could be an alternative option of the 6-month regimen among low-risk stage 3 patients. Among high-risk stage 3 patients, 6-month oxaliplatin-based regimens still seem more competitive. In addition, clinical application of 12-month capecitabine monotherapy should be cautious, despite its top rankings, especially among non-Asian countries.

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“…The inconsistency factor (IF) was applied as the quantitative indicator that suggested the existence of inconsistency once its 95% CI excluded zero. 26 Meanwhile, the Q statistic of inconsistency was another statistical indicator to numerically estimate the consistency within the comparisons, whose p value (<0.05) could suggest a significant inconsistency of network meta-analysis. Both consistency and homogeneity were crucial bases to offer reliable outcomes by network meta-analysis.…”

Section: Methodsmentioning

confidence: 99%

Multimodal treatments for resectable esophagogastric junction cancer: a systematic review and network meta-analysis

et al. 2019

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Background: Currently, preoperative chemoradiotherapy, perioperative chemotherapy and preoperative chemotherapy are recommended by NCCN, ESMO and Japanese guidelines respectively for resectable esophageal and junctional cancer. However, these recommendations are mainly based on esophageal cancer research. Therefore, specific for esophagogastric junction cancer, we conducted the first systematic review and network meta-analysis to rank all potential treatments simultaneously and hierarchically. Methods: Record retrieval was conducted in PubMed, Web of Science, Cochrane Central Register of Controlled Trials, Embase, ASCO and ESMO Meeting Library from inception to September 2018. Regarding time-to-event survival data, randomized controlled trials featuring comparisons between different multimodal treatments against resectable esophagogastric junction cancer were eligible. Overall survival was the endpoint. Network calculation was based on a random-effects model and the relative ranking of each node was numerically indicated by P-score (CRD42018110369, registration identifier of the meta-analysis in PROSPERO.). Results: Eight studies were included in our systematic review, corresponding to 1218 patients. Regarding overall survival, ‘PreCRT’ (preoperative chemoradiotherapy) topped the hierarchy (HR 1.00, P-score = 0.823), better than ‘PeriCT’ (perioperative chemotherapy; HR 1.32, P-score = 0.591) and ‘PreCT’ (preoperative chemotherapy; HR 1.54, P-score = 0.428). In sensitivity analyses, irrespective of interchanging to fixed-effects model or removing potentially heterogeneous studies, relative rankings remained stable and ‘PreCRT’ was still the optimal node. Conclusion: Preoperative chemoradiotherapy could potentially be the optimal multimodal treatment, which displayed more overall survival benefits than perioperative chemotherapy and preoperative chemotherapy among resectable esophagogastric junction cancer patients. To further verify our pooled results, more randomized trials will be needed to compare preoperative chemoradiotherapy with perioperative chemotherapy (especially FLOT-based regimens).

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Comparative efficacy and tolerability of antiemetic prophylaxis for adult highly emetogenic chemotherapy: A network meta‐analysis of 143 randomized controlled trials

Cited by 5 publications

References 28 publications

First-line systemic therapy for advanced gastric cancer: a systematic review and network meta-analysis

First-line systemic therapy for advanced gastric cancer: a systematic review and network meta-analysis

Comparative efficacy and tolerability of adjuvant systemic treatments against resectable colon cancer: a network meta-analysis

Multimodal treatments for resectable esophagogastric junction cancer: a systematic review and network meta-analysis

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