Evaluating Risks and Benefits of Evolving Systemic Treatments of Neuroendocrine Tumors
A partir d'une revue systématique de la littérature publiée entre 1947 et 2018 (30 essais randomisés, 3 895 patients), cette méta-analyse compare l'efficacité, du point de vue du taux de contrôle de la maladie, de la survie sans progression, de la survie globale, et la toxicité des différentes thérapies systémiques utilisées chez des patients atteints d'une tumeur neuro-endocrine gastro-intestinale ou pancréatique
In recent years, the number of treatments for metastatic, well-differentiated gastrointestinal and pancreatic neuroendocrine tumors (NETs) has expanded significantly. New medications for tumor control as well as symptom control include somatostatin analogues, everolimus, sunitinib, telotristat, and lutetium Lu 177 (177Lu)-dotatate. These new therapies have been approved based on randomized clinical trials—an effort that has required international cooperation given the relative scarcity of metastatic NETs.With the introduction of new therapies, the problem of treatment sequencing has arisen. Most studies in the NET field have compared new treatments with a placebo or with a comparator of unknown efficacy (eg, high-dose octreotide in the Neuroendocrine Tumors Therapy (NETTER-1) registration trial for 177Lu-dotatate). Hence, it is difficult to compare various active therapies and contrast benefits and risks. To try to compare evidence across trials, Kaderli et al embarked on a systematic review and network meta-analysis of randomized clinical trials. Their goal was to compare disease control, progression-free survival, overall survival, toxic effects, and quality of life across trials, assigning a P score, which measures the extent of certainty that one treatment is superior to another, averaged over all competing therapies.
JAMA Oncology , commentaire, 2018