title: A Bayesian network meta-analysis on second-line systemic therapy in advanced gastric cancer.
abstract: BACKGROUND
  It is unclear which regimen is the most efficacious among the available therapies for advanced gastric cancer in the second-line setting. We performed a network meta-analysis to determine their relative benefits.
  
  
  METHODS
  We conducted a systematic review of randomized controlled trials (RCTs) through the MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases and American Society of Clinical Oncology abstracts up to June 2014 to identify phase III RCTs on advanced gastric cancer in the second-line setting. Overall survival (OS) data were the primary outcome of interest. Hazard ratios (HRs) were extracted from the publications on the basis of reported values or were extracted from survival curves by established methods. A Bayesian network meta-analysis was performed with WinBUGS to compare all regimens simultaneously.
  
  
  RESULTS
  Eight RCTs (2439 patients) were identified and contained extractable data for quantitative analysis. Network meta-analysis showed that paclitaxel plus ramucirumab was superior to single-agent ramucirumab [OS HR 0.51, 95 % credible region (CR) 0.30-0.86], paclitaxel (OS HR 0.81, 95 % CR 0.68-0.96), docetaxel (OS HR 0.56, 95 % CR 0.33-0.94), and irinotecan (OS HR 0.71, 95 % CR 0.52-0.99). Paclitaxel plus ramucirumab also had an 89 % probability of being the best regimen among all these regimens. Single-agent ramucirumab, paclitaxel, docetaxel, and irinotecan were comparable to each other with respect to OS and were superior to best supportive care.
  
  
  CONCLUSIONS
  This is the first network meta-analysis to compare all second-line regimens reported in phase III gastric cancer trials. The results suggest the paclitaxel plus ramucirumab combination is the most effective therapy and should be the reference regimen for future comparative trials.
authors.affiliation: Cross Cancer Institute, Edmonton , AB, T6G 1Z2, Canada.
authors.forename: Xiaofu
authors.initials: X
authors.lastname: Zhu
authors.affiliation: Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, M4N 3M5, Canada.
authors.forename: Yoo-Joung
authors.initials: YJ
authors.lastname: Ko
authors.affiliation: Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, M4N 3M5, Canada.
authors.forename: Scott
authors.initials: S
authors.lastname: Berry
authors.affiliation: Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, M4N 3M5, Canada.
authors.forename: Keya
authors.initials: K
authors.lastname: Shah
authors.affiliation: Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, M4N 3M5, Canada.
authors.forename: Esther
authors.initials: E
authors.lastname: Lee
authors.affiliation: Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, M4N 3M5, Canada. kelvin.chan@sunnybrook.ca.|Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada. kelvin.chan@sunnybrook.ca.|Canadian Centre for Applied Research in Cancer Control (ARCC), Toronto, Canada. kelvin.chan@sunnybrook.ca.
authors.forename: Kelvin
authors.initials: K
authors.lastname: Chan
mesh_terms: D006801:Humans; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001499:Bayes Theorem; D016879:Salvage Therapy / Q000379:methods; D013274:Stomach Neoplasms / Q000188:drug therapy; D016032:Randomized Controlled Trials as Topic
chemical_list: D000970:Antineoplastic Agents
keywords: Gastric cancer; Network meta-analysis; Second-line therapy; Systemic therapy