Comparative efficacy and safety of first-line treatments in patients with metastatic renal cell cancer: a network meta analysis based on phase 3 RCTs

It is impossible to conduct head-to-head trials of all the therapies to determine optimal treatment in the rapidly advancing era of therapies for metastatic renal cell carcinoma (mRCC). In this network meta-analysis,we aimed to compare efficacy and safety of first -line treatments for mRCC. We searched PubMed, Embase, the Cochrane Central Register of Controlled Trials, and unpublished studies were also sought through "clinicaltrials.gov" from their inception through January 31, 2016. A database search identified 1253 articles, with 11 studies meeting the eligibility criteria. A total of 7597 patients in twelve different treatment arms were assessed. Network meta-analysis showed sunitinib had a significantly longer PFS than IFN-a (SMD=5.68; 95%CI: -10.76,-0.86; P<0.001) and placebo (SMD=-6.71; 95%CI: -12.65,0.79; P<0.001), meanwhile, pazopanib had a significantly longer PFS compared with placebo (SMD=5.13; 95%CI: 0.43, 10.09; P<0.001). The cumulative ranking probability curve indicated that sunitinib had the highest probability of being the best treatment modality in terms of PFS and it also had the highest probability of being the safest drugs as the first -line treatment when it came to SAE. Thus, sunitinib might be the best choice of first -line treatment for patients with mRCC because it has the most favorable balance between efficacy and safety.