Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Aug 10, 2015; 6(4): 73-79
Published online Aug 10, 2015. doi: 10.5306/wjco.v6.i4.73
Second-line treatments for advanced gastric cancer: Interpreting outcomes by network meta-analysis
Brigitta Badiani, Dario Maratea, Andrea Messori
Brigitta Badiani, Dario Maratea, Andrea Messori, HTA Unit, ESTAV Toscana Centro, Regional Health Service, 50100 Firenze, Italy
Author contributions: Badiani B performed the literature search and conducted the Bayesian meta-analysis; Maratea D checked the information from the clinical trials and contributed to the writing of the manuscript; Messori A wrote the manuscript and supervised all phases of the research.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at andrea.messori.it@gmail.com
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Andrea Messori, PhD, HTA Unit, ESTAV Toscana Centro, Regional Health Service, Via San Salvi 12, 50100 Firenze, Italy. andrea.messori.it@gmail.com
Fax: +39-5-74701319
Received: February 12, 2015
Peer-review started: February 14, 2015
First decision: March 6, 2015
Revised: April 8, 2015
Accepted: May 16, 2015
Article in press: May 18, 2015
Published online: August 10, 2015
Abstract

AIM: To study the effectiveness of second-line treatments for advancer gastric cancer by application of Bayesian network meta-analysis.

METHODS: Our search covered the literature up to February 2015. The following 6 treatments were evaluated: (1) irinotecan (camptothecins); (2) paclitaxel (taxanes class); (3) docetaxel (taxanes); (4) everolimus (mammalian target of rapamycin inhibitors); (5) ramucirumab (vascular endothelial growth factor receptor 2 inhibitors); (6) ramucirumab + paclitaxel. Our methodology was based on standard models of Bayesian network meta-analysis. The reference treatment was best supportive care (BSC). The end-point was overall survival. Median survival was the outcome measure along with 95% credible intervals.

RESULTS: Our search identified a total of 7 randomized controlled trials. These trials included 2298 patients (in 15 treatment arms) in whom a total of 6 active treatments were evaluated as well as BSC. There were 21 head-to-head comparisons (6 direct, 15 indirect). The difference in survival between each of two active treatments (paclitaxel and ramucirumab + paclitaxel) vs BSC was statistically significant, while the other 4 showed no statistical difference. In the 6 head-to-head comparisons between active treatments, no significant survival difference was demonstrated.

CONCLUSION: Our results indicate that both paclitaxel monotherapy and ramucirumab + paclitaxel determine a significant prolongation in survival as compared with BSC.

Keywords: Meta-analysis, Bayesian methods, Advancer gastric cancer, Second line therapy, Paclitaxel, Irinotecan, Docetaxel, Ramucirumab

Core tip: We carried out a Bayesian network meta-analysis to evaluate second-line treatments for advancer gastric cancer. After scanning the literature up to February 2015, 7 randomized controlled trials were included in our meta-analysis in which the treatments for this disease condition and best supportive care (BSC) were evaluated according to overall survival (OS). Our meta-analysis investigated 21 direct or indirect comparisons. The difference in OS between paclitaxel vs BSC and ramucirumab + paclitaxel vs BSC was statistically significant, while the other comparisons showed no statistical difference. In conclusion, our results indicate that both paclitaxel and ramucirumab + paclitaxel determine a significant prolongation in survival in comparison with BSC.