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SYSTEMATIC REVIEW article

Front. Oncol.
Sec. Genitourinary Oncology
Volume 14 - 2024 | doi: 10.3389/fonc.2024.1468784
This article is part of the Research Topic Advances in the Treatment of Urothelial Carcinoma View all articles

Efficacy and safety of the first-line systemic treatments in patients with advanced-stage urothelial carcinoma: A systematic review and network meta-analysis

Provisionally accepted
Yang Zhao Yang Zhao 1Xiaoqing Xu Xiaoqing Xu 2Yuhan Sun Yuhan Sun 1Xinyang Yu Xinyang Yu 1Yuanfu Qi Yuanfu Qi 2Xin Dai Xin Dai 2,3*
  • 1 First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
  • 2 Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
  • 3 Shandong University, Jinan, China

The final, formatted version of the article will be published soon.

    In recent years, some clinical studies of first-line treatment for advanced-stage urothelial carcinoma (aUC) have reached the main endpoint, showing inconsistent clinical efficacy.We hope to explore the efficacy and safety of first-line treatment for aUC.The relevant literature from January 2000 to February 2024 was searched, and the R language (version 4.3.1) was used to perform a network meta-analysis based on the JAGS package and GEMTC package under the Bayesian framework. The main indicators included OS, PFS, ORR and adverse events of grade 3 or higher. This study has been registered in PROSPERO (CRD42024525372).Results: A total of 8 RCTs involving 5539 patients and 12 treatments were included. Pembrolizumab plus Enfortumab Vedotin (PEM+EV) was significantly better than other groups in OS, PFS and ORR. In terms of OS, PEM+EV was significantly better than nivolumab plus platinum-based chemotherapy (NIVO+platinumCT) (HR=0.60; 95% CI: 0.45-0.81), PEM+platinumCT (HR=0.55; 95%CI: 0.42-0.72), atezolizumab (ATE) + platinumCT (HR=0.57; 95 %CI: 0.43-0.75) and platinumCT (HR=0.47; 95%CI: 0.38-0.58). In terms of PFS, PEM+EV was also significantly better than NIVO+platinumCT (HR=0.62; 95%CI: 0.48-0.82), PEM+platinumCT (HR=0.58; 95%CI: 0.45-0.74), ATE+platinumCT (HR=0.55; 95%CI: 0.43-0.69) and platinumCT (HR=0.45; 95%CI: 0.38-0.54). In terms of ORR, PEM+EV had a significant be nefit compared with other treatment measures, which was 2.63 times that of platinumCT (OR=2.63; 95%CI: 2.00-3.45). The adverse events of grade 3 or higher in immunotherapy (ATE, PEM, durvalumab) was significantly lower than other treatment measures.Conclusions: PEM+EV can significantly prolong OS and PFS compared with other treatments, and has a higher ORR. The adverse events of grade 3 or higher of ATE was the lowest.

    Keywords: Advanced-stage, urothelial carcinoma, Network meta-analysis, First-line treatments, Immunotherapy, Antibody-drug conjugates

    Received: 22 Jul 2024; Accepted: 29 Aug 2024.

    Copyright: © 2024 Zhao, Xu, Sun, Yu, Qi and Dai. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Xin Dai, Shandong University, Jinan, China

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