Chengqiang Mo, Jin Sheng, Wulin Tan, Jingchao Liu, Zhou Yu, Xu Chen, Xiaopeng Mao, Shaopeng Qiu
Objectives: To compare five molecular targeted drugs (MTD) with interferon-α (IFN-α) and evaluate their clinical efficacy and adverse events as first line therapy for metastatic renal cell carcinoma (mRCC).
Methods: We conducted a systemic review and network meta-analysis of all relevant randomized controlled trials (RCTs) assessing MTD and IFN-αthrough a comprehensive search of databases including PubMed, Science Direct, Embase and Cochrane Library databases from January 2005 to April 2014.
Results: Eight articles with 4,718 patients were finally identified. No statistically significant difference existed between direct and indirect evidences and the convergence of analysing model was guaranteed. With INF-αas baseline, the OR values of five MTD (pazopanib, axitinib, bevacizumab + INF-α, sunitinib, sofafenib) in terms of objective response rate (ORR), were separately: 4.00, 95% CI, 0.25-52.88); 3.46, 95% CI, 0.16-52.20); 3.21, 95% CI, 0.84-12.79); 2.94, 95% CI, 0.55-12.81); 1.18, 95% CI, 0.17-6.63). When it comes to adverse events, the OR values and 95% CI of 5 MTD (sunitinib, bevacizumab + INF-α, axitinib, pazopanib, sofafenib) were separately: 3.65, 95% CI, 0.65-20.32; 3.22, 95% CI, 0.71-16.06; 1.77, 95% CI, 0.07-47.59; 1.45, 95% CI, 0.08-31.05; 0.65, 95% CI, 0.09-4.25. The probabilities of being the most efficacious treatments in terms of ORR were: pazopanib (37%), axitinib (34%), bevacizumab + IFN (21%), sunitinib (8%), sorafinib (1%) and IFN (0%). The probabilities of having least ≥ grade 3 adverse events were: sorafenib (52%), pazopanib (18%), IFN-α (17%), axitinib (11%), bevacizumab + IFN-α (1%), sunitinib (0%).
Conclusions: MTD was found to be superior to IFN-α in ORR but possessed of more ≥ grade 3 adverse events as first line treatment for patients with mRCC. Pazopanib, an oral MTD, was identified as a relatively rational choice. More well-designed and qualified trials are required to confirm these findings and investigate the clinical effective of MTD for the treatment of mRCC.
