Cochrane · systematic review · CD013798
First‐line therapy for adults with advanced renal cell carcinoma: a systematic review and network meta‐analysis
Aldin, A, Besiroglu, B, Adams, A, et al. · Cochrane Database of Systematic Reviews · 2023 · Cochrane Library
UrologyAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
29
current version
GRADE rated
4
No studies
16
Included studies
NR
No studies 16 · 55.2%Ungraded 9 · 31%Very low 0 · 0%Low 1 · 3.4%Moderate 3 · 10.3%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Summary of findings table for all risk groups combined
Population: people with a confirmed diagnosis of advanced renal cell carcinoma (combined risk groups) without previous systemic anticancer therapy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall survival (OS) ‐ Network (subnet 1) included 19 pairwise comparisons ‐ Median | HR 0.73 [0.5, 1.07] | 17 studies · 9705 participants | Moderate Downgraded: risk of bias, imprecision, indirectness |
Quality of life (QoL) We reported this outcome narratively in this review. Here, long‐term results (i.e., at the end of treatment) are presented. In the comparison PAZ versus SUN, QoL was measured using FACIT‐F (score range 0‐52; higher scores rep... | no estimate extracted | NR | No studies |
Serious adverse events (SAEs) ‐ Network included 31 pairwise comparisons ‐ Mean risk with SUN across trials3 included in this network: 40.7% | RR 1.29 [0.9, 1.85] | 22 studies · 10709 participants | Moderate Downgraded: risk of bias, imprecision, indirectness |
Progression‐free survival (PFS) ‐ Network (subnet 1) included 27 pairwise comparisons ‐ Median | HR 0.68 [0.52, 0.89] | 25 studies · 11737 participants | Moderate Downgraded: risk of bias, imprecision, indirectness |
Adverse events (AEs) (grade 3 or 4) ‐ Network included 19 pairwise comparisons ‐ Mean risk with SUN across trials3 in this network: 70.6% | no estimate extracted | 13 studies · 6909 participants | Ungraded |
Time to initiation of first subsequent therapy This outcome was not reported as a time‐to‐event outcome. Instead, authors of the trials reported the number of participants who received subsequent anticancer therapy after discontinuation of trial t... | RR 0.72 [0.64, 0.81] | 1 study · 861 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Summary of findings table for the favourable risk groups (according to IMDC and MSKCC)
Population: people with a confirmed diagnosis of advanced renal cell carcinoma (RCC) and a favourable risk according to the International Metastatic RCC Database Consortium (IMDC) and Memorial Sloan‐Kettering Cancer Center (MSKCC) risk models
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
IMDC risk group | no estimate extracted | NR | No studies |
Overall survival (OS) ‐ Network (subnet 1) included 5 pairwise comparisons ‐ Median | no estimate extracted | 4 studies · 933 participants | Ungraded |
Serious adverse events | no estimate extracted | NR | No studies |
Quality of life | no estimate extracted | NR | No studies |
Progression‐free survival (PFS) ‐ Network (subnet 1) included 5 pairwise comparisons ‐ Median | no estimate extracted | 4 studies · 933 participants | Ungraded |
Adverse events (grade 3 to 4) | no estimate extracted | NR | No studies |
Time to initiation of first subsequent therapy | no estimate extracted | NR | No studies |
MSKCC risk group | no estimate extracted | NR | No studies |
Overall survival (OS) ‐ Network (subnet 1) included 3 pairwise comparisons ‐ Median | no estimate extracted | 2 studies · 594 participants | Ungraded |
Serious adverse events (SAEs) | no estimate extracted | NR | No studies |
Quality of life (QoL) | no estimate extracted | NR | No studies |
Progression‐free survival (PFS) ‐ Network (subnet 1) included 7 pairwise comparisons ‐ Median | no estimate extracted | 6 studies · 784 participants | Ungraded |
Summary of findings for the intermediate and poor risk groups (according to IMDC and MSKCC)
Population: people with a confirmed diagnosis of advanced renal cell carcinoma (RCC) and an intermediate or poor risk according to the International Metastatic RCC Database Consortium (IMDC) and Memorial Sloan ‐Kettering Cancer Center (MSKCC) risk models
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
IMDC risk groups | no estimate extracted | NR | No studies |
Overall survival (OS) ‐ Network (subnet 1) included 10 pairwise comparisons ‐ Median | no estimate extracted | 5 studies · 2908 participants | Ungraded |
Quality of life | no estimate extracted | NR | No studies |
Serious adverse events | no estimate extracted | NR | No studies |
Progression‐free survival (PFS) ‐ Network (subnet 1) included 11 pairwise comparisons ‐ Median | no estimate extracted | 5 studies · 2908 participants | Ungraded |
Adverse events (grade 3 or 4) | no estimate extracted | NR | No studies |
Time to initiation of first subsequent therapy | no estimate extracted | NR | No studies |
MSKCC risk groups | no estimate extracted | NR | No studies |
Overall survival (OS) ‐ Network included 15 pairwise comparisons ‐ Median | no estimate extracted | 7 studies · 3937 participants | Ungraded |
Quality of life (QoL) | no estimate extracted | NR | No studies |
Progression‐free survival (PFS) ‐ Network (subnet 1) included 10 pairwise comparisons ‐ Median | no estimate extracted | 5 studies · 1522 participants | Ungraded |