A network meta-analysis of treatment for newly diagnosed glioblastoma based on radiotherapy plus temozolomide
- Author:
Mao-hua Zheng
;
Hong-tao Sun
;
Ji-guang Xu
;
Yong-hong Zhang
;
Gang Yang
;
Lei-ming Huo
;
Jin-hui Tian
;
Ke-hu Yang
;
Mao-hua Zheng
;
Hong-tao Sun
- Publication Type:Journal Article
- Keywords:
newly diagnosed glioblastoma;
radiotherapy;
temozolomide;
network meta-analysis;
randomized controlled trials
- MeSH:
Glioblastoma
- From:Neurology Asia
2017;22(1):49-58
- CountryMalaysia
- Language:English
-
Abstract:
Background & Objective: Radiotherapy and temozolomide are the standard therapy for newly diagnosed
glioblastoma multiforme (GBM). However, it is unclear whether adding another agent to the commonly
used radiotherapy-temozolomide (RT + TMZ) benefits newly diagnosed GBM patients. The present
network meta-analysis aimed to assess the efficacy of combining other agents with RT + TMZ for
GBM treatment.
Methods: A comprehensive literature search was conducted on PubMed, EMBASE.com, Web of
Science, and the Cochrane Central Register of Controlled Trials from inception to September 23, 2014,
to include all randomized controlled trials of RT + TMZ-based therapy in GBM patients. Pairwise and
network meta-analyses were performed to compare the therapeutic regimens. Results: Seventeen studies
involving 4,148 patients were identified. The results of pairwise meta-analysis indicated no significant
differences among most comparison groups, except for bevacizumab + RT + TMZ versus RT + TMZ
for progression-free survival (hazard ratio [HR] = 0.71, 95% confidence interval [CI]: 0.59–0.86; P =
0.000) and RT + TMZ versus RT alone for overall survival (HR = 0.71, 95% CI: 0.58–0.88; P = 0.001).
The results of network meta-analysis also showed no significant differences in most comparisons;
however, adverse events were more common among patients receiving additional therapeutic agents
other than RT + TMZ. The ranking probability analysis indicated that bevacizumab + RT + TMZ and
nimustine + cisplatin + RT + TMZ were associated with the best progression-free and overall survival,
but they also caused the most adverse events in GBM patients. RT + bevacizumab + irinotecan had
the highest probability of being the best regimen for minimizing adverse events.
Conclusions: The addition of other targeted agents, particularly bevacizumab and nimustine, to
RT + TMZ could be slightly effective for the treatment of newly diagnosed GBM patients; however,
adverse events remained common.
- Full text:P020170413327999468855.pdf
