Adjuvant Systemic Treatment for Renal Cancer After Surgery: A Network Meta-Analysis
BackgroundApproximately 15% to 20% of patients will experience disease recurrence following surgical removal of renal cell carcinoma. A range of pharmacological agents is prescribed for metastatic renal cell carcinoma, but there are trials testing whether these have an earlier role in the adjuvant s...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-09-01
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| Series: | Société Internationale d’Urologie Journal |
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| Online Access: | https://siuj.org/index.php/siuj/article/view/206/148 |
| _version_ | 1797225298885869568 |
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| author | Niranjan J. Sathianathen Marc A. Furrer Christopher J. Weight Declan G. Murphy Shilpa Gupta Nathan Lawrentschuk |
| author_facet | Niranjan J. Sathianathen Marc A. Furrer Christopher J. Weight Declan G. Murphy Shilpa Gupta Nathan Lawrentschuk |
| author_sort | Niranjan J. Sathianathen |
| collection | DOAJ |
| description | BackgroundApproximately 15% to 20% of patients will experience disease recurrence following surgical removal of renal cell carcinoma. A range of pharmacological agents is prescribed for metastatic renal cell carcinoma, but there are trials testing whether these have an earlier role in the adjuvant setting. We aim to assess the efficacy of adjuvant systemic treatment following surgery in patients with renal cell carcinoma and to determine the most effective treatment.
MethodsThe protocol for this review was published in PROSPERO (CRD42021281588). We searched multiple databases up to August 2021. We included only randomized trials of patients with renal cell carcinoma that had been completely resected. We included patients with locoregional nodal disease if it was surgically removed, and excluded all cases of metastatic disease. We included all adjuvant systemic therapies that were commenced within 90 days of renal surgery. A network meta-analysis was performed using a frequentist approach.
ResultsA total of 13 studies with 8103 patients were included for analysis. Only pembrolizumab (HR 0.74; 95%CI 0.57 to 0.96) and pazopanib (HR 0.80; 95%CI 0.68 to 0.95) improved disease-free survival compared with observation. These 2 treatments were the 2 highest ranked comparisons with a P-score of 0.87 and 0.80. No agent improved overall survival. All agents increased the risk of severe adverse events compared with observation.
ConclusionsPembrolizumab and pazopanib were the only 2 adjuvant agents that improved time to disease recurrence compared with observation, with the former likely being the more efficacious. None of the treatments improved overall survival and almost all increased severe adverse events. |
| first_indexed | 2024-03-08T18:30:54Z |
| format | Article |
| id | doaj.art-9a3868f99dd945bf8bb7b2fe1f7d22ce |
| institution | Directory Open Access Journal |
| issn | 2563-6499 |
| language | English |
| last_indexed | 2024-04-24T14:06:48Z |
| publishDate | 2022-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Société Internationale d’Urologie Journal |
| spelling | doaj.art-9a3868f99dd945bf8bb7b2fe1f7d22ce2024-04-03T10:08:39ZengMDPI AGSociété Internationale d’Urologie Journal2563-64992022-09-013534135210.48083/WIXM2804Adjuvant Systemic Treatment for Renal Cancer After Surgery: A Network Meta-AnalysisNiranjan J. SathianathenMarc A. FurrerChristopher J. WeightDeclan G. MurphyShilpa GuptaNathan LawrentschukBackgroundApproximately 15% to 20% of patients will experience disease recurrence following surgical removal of renal cell carcinoma. A range of pharmacological agents is prescribed for metastatic renal cell carcinoma, but there are trials testing whether these have an earlier role in the adjuvant setting. We aim to assess the efficacy of adjuvant systemic treatment following surgery in patients with renal cell carcinoma and to determine the most effective treatment. MethodsThe protocol for this review was published in PROSPERO (CRD42021281588). We searched multiple databases up to August 2021. We included only randomized trials of patients with renal cell carcinoma that had been completely resected. We included patients with locoregional nodal disease if it was surgically removed, and excluded all cases of metastatic disease. We included all adjuvant systemic therapies that were commenced within 90 days of renal surgery. A network meta-analysis was performed using a frequentist approach. ResultsA total of 13 studies with 8103 patients were included for analysis. Only pembrolizumab (HR 0.74; 95%CI 0.57 to 0.96) and pazopanib (HR 0.80; 95%CI 0.68 to 0.95) improved disease-free survival compared with observation. These 2 treatments were the 2 highest ranked comparisons with a P-score of 0.87 and 0.80. No agent improved overall survival. All agents increased the risk of severe adverse events compared with observation. ConclusionsPembrolizumab and pazopanib were the only 2 adjuvant agents that improved time to disease recurrence compared with observation, with the former likely being the more efficacious. None of the treatments improved overall survival and almost all increased severe adverse events.https://siuj.org/index.php/siuj/article/view/206/148renal cancerimmunotherapysystematic review |
| spellingShingle | Niranjan J. Sathianathen Marc A. Furrer Christopher J. Weight Declan G. Murphy Shilpa Gupta Nathan Lawrentschuk Adjuvant Systemic Treatment for Renal Cancer After Surgery: A Network Meta-Analysis Société Internationale d’Urologie Journal renal cancer immunotherapy systematic review |
| title | Adjuvant Systemic Treatment for Renal Cancer After Surgery: A Network Meta-Analysis |
| title_full | Adjuvant Systemic Treatment for Renal Cancer After Surgery: A Network Meta-Analysis |
| title_fullStr | Adjuvant Systemic Treatment for Renal Cancer After Surgery: A Network Meta-Analysis |
| title_full_unstemmed | Adjuvant Systemic Treatment for Renal Cancer After Surgery: A Network Meta-Analysis |
| title_short | Adjuvant Systemic Treatment for Renal Cancer After Surgery: A Network Meta-Analysis |
| title_sort | adjuvant systemic treatment for renal cancer after surgery a network meta analysis |
| topic | renal cancer immunotherapy systematic review |
| url | https://siuj.org/index.php/siuj/article/view/206/148 |
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