A Bayesian Meta-Analysis of Multiple Treatment Comparisons of Systemic Regimens for Advanced Pancreatic Cancer
A Bayesian Meta-Analysis of Multiple Treatment Comparisons of Systemic Regimens for Advanced Pancreatic Cancer
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DOI：
10.1371/journal.pone.0108749
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发表时间：
2014-10-06
期刊：
影响因子：
3.7
通讯作者：
Ko, Yoo-Joung
中科院分区：
文献类型：
--
作者：
Chan, Kelvin;Shah, Keya;Ko, Yoo-Joung
背景：对于晚期胰腺癌，在随机对照试验中，许多方案与吉西他滨(G)作为标准组进行了比较。在随机对照试验中，很少有方案直接相互比较，它们之间的相对疗效和安全性尚不清楚。方法：通过MEDLINE、EMBASE、Cochrane中央对照试验注册库和ASCO会议摘要进行系统回顾，以确定包括晚期胰腺癌的随机对照试验，比较以下方案：G、G+5-氟尿嘧啶、G+卡培他滨、G+S1、G+顺铂、G+奥沙利铂、G+厄洛替尼、G+ nab-紫杉醇和FOLFIRINOX。使用Parmar方法提取95%可信区域的总生存期和无进展生存期。贝叶斯多重治疗比较同时进行比较所有方案。结果：22项研究被确定，16项纳入meta分析。所有试验中G组的中位总生存期、无进展生存期和缓解率相似，表明没有显著的临床异质性。对于总生存率，混合治疗比较发现，FOLFIRINOX为最佳方案的概率为83%，而G+ nab-紫杉醇为11%，G+S1和G+厄洛替尼分别为3%。FOLFIRINOX与G+ nab-紫杉醇的总生存风险比为0.79[0.50-1.24]，毒性无明显差异。直接两两比较的风险比与混合处理比较的结果一致。结论：通过间接比较，FOLFIRINOX似乎是晚期胰腺癌的最佳方案，与其他方案相比，有改善生存的趋势。
Background: For advanced pancreatic cancer, many regimens have been compared with gemcitabine (G) as the standard arm in randomized controlled trials. Few regimens have been directly compared with each other in randomized controlled trials and the relative efficacy and safety among them remains unclear.Methods: A systematic review was performed through MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and ASCO meeting abstracts up to May 2013 to identify randomized controlled trials that included advanced pancreatic cancer comparing the following regimens: G, G+5-fluorouracil, G+ capecitabine, G+S1, G+ cisplatin, G+oxaliplatin, G+ erlotinib, G+ nab-paclitaxel, and FOLFIRINOX. Overall survival and progression-free survival with 95% credible regions were extracted using the Parmar method. A Bayesian multiple treatment comparisons was performed to compare all regimens simultaneously.Results: Twenty-two studies were identified and 16 were included in the meta-analysis. Median overall survival, progression free survival, and response rates for G arms from all trials were similar, suggesting no significant clinical heterogeneity. For overall survival, the mixed treatment comparisons found that the probability that FOLFIRINOX was the best regimen was 83%, while it was 11% for G+ nab-paclitaxel and 3% for G+S1 and G+ erlotinib, respectively. The overall survival hazard ratio for FOLFIRINOX versus G+ nab-paclitaxel was 0.79 [0.50-1.24], with no obvious difference in toxicities. The hazard ratios from direct pairwise comparisons were consistent with the mixed treatment comparisons results.Conclusions: FOLFIRINOX appeared to be the best regimen for advanced pancreatic cancer probabilistically, with a trend towards improvement in survival when compared with other regimens by indirect comparisons.