Second-line treatments for advanced gastric cancer: Interpreting outcomes by network meta-analysis.
OBJECTIVE
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.


CONCLUSIONS
Our results indicate that both paclitaxel monotherapy and ramucirumab + paclitaxel determine a significant prolongation in survival as compared with BSC.
Brigitta Badiani, Dario Maratea, Andrea Messori, HTA Unit, ESTAV Toscana Centro, Regional Health Service, 50100 Firenze, Italy.
Brigitta
B
Badiani
Brigitta Badiani, Dario Maratea, Andrea Messori, HTA Unit, ESTAV Toscana Centro, Regional Health Service, 50100 Firenze, Italy.
Dario
D
Maratea
Brigitta Badiani, Dario Maratea, Andrea Messori, HTA Unit, ESTAV Toscana Centro, Regional Health Service, 50100 Firenze, Italy.
Andrea
A
Messori
Advancer gastric cancer; Bayesian methods; Docetaxel; Irinotecan; Meta-analysis; Paclitaxel; Ramucirumab; Second line therapy