Sunitinib and bevacizumab for first-line treatment of metastatic renal cell carcinoma: a systematic review and indirect comparison of clinical effectiveness
Thompson Coon JS et al. - In a study to explore the evidence from all available randomised clinical trials of sunitinib and bevacizumab, in combination with interferon-α (IFN-α), in treatment of advanced metastatic renal cell carcinoma (RCC), 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 pts with metastatic RCC. Methods- Systematic literature searches were performed in 6 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 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 2 reviewers with disagreements being settled by discussion.
- Effects of sunitinib and bevacizumab (in combination with IFN-α) on progression-free survival (PFS) were compared indirectly using Bayesian Markov Chain Monte-Carlo (MCMC) sampling in Win BUGS, with IFN as a common comparator.
Results- 3 studies were included.
- Median PFS was significantly prolonged with both interventions (from 5 mos to between 8 and 11 mos) compared with IFN.
- Overall survival was also prolonged, compared with IFN, although published data are not fully mature.
- Indirect comparison suggests that sunitinib is superior to bevacizumab plus IFN in terms of PFS.
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