NETWORK META-ANALYSIS OF RANDOMIZED TRIALS FOR SECOND OR LATER-LINE TREATMENTS OF METASTATIC LIPOSARCOMA

초록

Objective Soft tissue sarcomas (STS) are heterogeneous diseases and span a broad range of differentiation including adipocytes, smooth or striated muscles, and other several origins. It is well known that different treatment sensitivity to chemotherapy for different histological subtypes. Current guideline usually recommends anthracycline-containing regimens for systemic treatment of locally advanced or metastatic STS. However, the vast majority of advanced STS undergo progression after first-line anthracycline based chemotherapy. Many chemotherapeutic agents have been tested and approved for patients with STS who have failed anthracycline-based chemotherapy. However only a few direct comparisons have been performed between those agents. We focused on liposarcoma, one of the most common and relatively chemotherapy sensitive STS. We performed a network meta-analysis (NMA)to compare and rank the regimens available for second or later line treatment for advanced liposarcoma in terms of progression-free survival (PFS). Methods We conducted a systematic literature review to identify eligible randomized trials meeting the following criteria: trials comparing the efficacy of second or later-line treatment for advanced sarcoma and trials including information of hazard ratios(HRs) for PFS of liposarcoma histology. A Bayesian NMA based on PFS with a fixed-effect model was performed to determine the ranking of second or later-line treatments and compare relative efficacies of the regimens. One of the most commonly used drugs, dacarbazine, was used as reference treatment. Results Five randomized trials were identified including five treatments: dacarbazine, eribulin, regorafenib, trabectedin, and placebo (best supportive care). One of the most commonly used regimen in practice, gemcitabine with docetaxel, was not included in this study because of not forming network framework with other several regimens. Two out of five drugs were significantly better in terms of PF