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Sunitinib and bevacizumab for first-line treatment of metastatic renal cell carcinoma: a systematic review and indirect comparison of clinical effectiveness

Sunitinib and bevacizumab for first-line treatment of metastatic renal cell carcinoma: a systematic review and indirect comparison of clinical effectiveness
Sunitinib and bevacizumab for first-line treatment of metastatic renal cell carcinoma: a systematic review and indirect comparison of clinical effectiveness
Background: Two new agents have recently been licensed for use in the treatment of metastatic renal cell carcinoma (RCC) in Europe. This paper aims to systematically review the evidence from all available randomised clinical trials of sunitinib and bevacizumab (in combination with interferon-? (IFN-?)) in the treatment of advanced metastatic RCC.

Methods: Systematic literature searches were performed in six electronic databases. Bibliographies of included studies were searched for further relevant studies. Individual conference proceedings were searched using their online interfaces. Studies were selected according to the predefined criteria. All randomised clinical trials of sunitinib or bevacizumab in combination with IFN for treating advanced metastatic RCC in accordance with the European licensed indication were included. Study selection, data extraction, validation and quality assessment were performed by two reviewers with disagreements being settled by discussion. The effects of sunitinib and bevacizumab (in combination with IFN-?) on progression-free survival were compared indirectly using Bayesian Markov Chain Monte-Carlo (MCMC) sampling in Win BUGS, with IFN as a common comparator.

Results: Three studies were included. Median progression-free survival was significantly prolonged with both interventions (from approximately 5 months to between 8 and 11 months) compared with IFN. Overall survival was also prolonged, compared with IFN, although the published data are not fully mature. Indirect comparison suggests that sunitinib is superior to bevacizumab plus IFN in terms of progression-free survival (hazard ratios 0.796; 95% CI 0.63–1.0; P=0.0272).

Conclusion: There is evidence to suggest that treatment with sunitinib and treatment with bevacizumab plus IFN has clinically relevant and statistically significant advantages over treatment with IFN alone in patients with metastatic RCC.
renal cancer, indirect comparison, systematic review, sunitinib, bevacizumab
0007-0920
238-243
Thompson Coon, J. S.
ef6426f4-cbb8-4159-9c4f-4eed7399eba7
Liu, Z.
f2d813f1-8806-4fd5-a719-2e9357f2453f
Hoyle, M.
af04245a-4935-4c89-93d0-2aefaad30ed2
Rogers, G.
fabda4cb-636a-4441-bcf7-050203c4bd3f
Green, C.
a4440ea4-08aa-4bde-810e-9b615150e39e
Moxham, T.
a98c30c4-b839-4028-9539-b9367d8f9dc0
Welch, K.
2603c214-aace-486f-8723-b006873248a5
Stein, K.
5f0b93b6-a47b-4976-b813-f498931d5286
Thompson Coon, J. S.
ef6426f4-cbb8-4159-9c4f-4eed7399eba7
Liu, Z.
f2d813f1-8806-4fd5-a719-2e9357f2453f
Hoyle, M.
af04245a-4935-4c89-93d0-2aefaad30ed2
Rogers, G.
fabda4cb-636a-4441-bcf7-050203c4bd3f
Green, C.
a4440ea4-08aa-4bde-810e-9b615150e39e
Moxham, T.
a98c30c4-b839-4028-9539-b9367d8f9dc0
Welch, K.
2603c214-aace-486f-8723-b006873248a5
Stein, K.
5f0b93b6-a47b-4976-b813-f498931d5286

Thompson Coon, J. S., Liu, Z., Hoyle, M., Rogers, G., Green, C., Moxham, T., Welch, K. and Stein, K. (2009) Sunitinib and bevacizumab for first-line treatment of metastatic renal cell carcinoma: a systematic review and indirect comparison of clinical effectiveness. British Journal of Cancer, 101 (2), 238-243. (doi:10.1038/sj.bjc.6605167). (PMID:19568242)

Record type: Article

Abstract

Background: Two new agents have recently been licensed for use in the treatment of metastatic renal cell carcinoma (RCC) in Europe. This paper aims to systematically review the evidence from all available randomised clinical trials of sunitinib and bevacizumab (in combination with interferon-? (IFN-?)) in the treatment of advanced metastatic RCC.

Methods: Systematic literature searches were performed in six electronic databases. Bibliographies of included studies were searched for further relevant studies. Individual conference proceedings were searched using their online interfaces. Studies were selected according to the predefined criteria. All randomised clinical trials of sunitinib or bevacizumab in combination with IFN for treating advanced metastatic RCC in accordance with the European licensed indication were included. Study selection, data extraction, validation and quality assessment were performed by two reviewers with disagreements being settled by discussion. The effects of sunitinib and bevacizumab (in combination with IFN-?) on progression-free survival were compared indirectly using Bayesian Markov Chain Monte-Carlo (MCMC) sampling in Win BUGS, with IFN as a common comparator.

Results: Three studies were included. Median progression-free survival was significantly prolonged with both interventions (from approximately 5 months to between 8 and 11 months) compared with IFN. Overall survival was also prolonged, compared with IFN, although the published data are not fully mature. Indirect comparison suggests that sunitinib is superior to bevacizumab plus IFN in terms of progression-free survival (hazard ratios 0.796; 95% CI 0.63–1.0; P=0.0272).

Conclusion: There is evidence to suggest that treatment with sunitinib and treatment with bevacizumab plus IFN has clinically relevant and statistically significant advantages over treatment with IFN alone in patients with metastatic RCC.

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More information

e-pub ahead of print date: 30 June 2009
Published date: 21 July 2009
Keywords: renal cancer, indirect comparison, systematic review, sunitinib, bevacizumab
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 351810
URI: https://eprints.soton.ac.uk/id/eprint/351810
ISSN: 0007-0920
PURE UUID: 1940e46b-fe5d-450a-ae5f-2e07ef290c95

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Date deposited: 24 Apr 2013 15:35
Last modified: 18 Jul 2017 04:23

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Contributors

Author: J. S. Thompson Coon
Author: Z. Liu
Author: M. Hoyle
Author: G. Rogers
Author: C. Green
Author: T. Moxham
Author: K. Welch
Author: K. Stein

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