Cargando…

A systematic review and network meta-analysis of the efficacy and safety of third-line and over third-line therapy after imatinib and TKI resistance in advanced gastrointestinal stromal tumor

Tyrosine kinase inhibitors (TKIs) have greatly improved the prognosis of unresectable and metastatic gastrointestinal stromal tumors (GISTs) in the last two decades. Imatinib and sunitinib are recommended as first-line and second-line therapies, respectively. However, there is a lack of precision th...

Descripción completa

Detalles Bibliográficos
Autores principales: Xiao, Xianhao, Yuan, Weiye, Wang, Chong, Song, He
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9720279/
https://www.ncbi.nlm.nih.gov/pubmed/36479203
http://dx.doi.org/10.3389/fphar.2022.978885
_version_ 1784843521689124864
author Xiao, Xianhao
Yuan, Weiye
Wang, Chong
Song, He
author_facet Xiao, Xianhao
Yuan, Weiye
Wang, Chong
Song, He
author_sort Xiao, Xianhao
collection PubMed
description Tyrosine kinase inhibitors (TKIs) have greatly improved the prognosis of unresectable and metastatic gastrointestinal stromal tumors (GISTs) in the last two decades. Imatinib and sunitinib are recommended as first-line and second-line therapies, respectively. However, there is a lack of precision therapy for refractory GISTs regarding therapy after imatinib and sunitinib. We comprehensively searched electronic databases, including PubMed, EMBASE, Web of Science, Cochrane Library, and ClinicalTrials, from inception to October 2022. Randomized controlled trials featuring comparisons with third-line or over third-line therapies against GISTs were eligible. The primary outcome was progression-free survival (PFS). All network calculations were performed using random effect models, and the ranking of regimens were numerically based on the surface under the cumulative ranking (SUCRA) statistics. A total of seven studies were eligible for inclusion in this network meta-analysis. After analysis, ripretinib was ranked at the top in progression-free survival (PFS), overall survival (OS), and disease control rate (DCR) (SUCRA statistics: 83.1%, 82.5%, and 86.5%, respectively), whereas nilotinib and pimitespib presented better tolerability (SUCRA statistics: 64.9% and 63.8%, respectively). We found that regorafenib seemed more reliable for clinical administration, and ripretinib showed good effectiveness for the over third-line therapy. Precise targeted therapy is a critical direction for the future treatment of GIST, and more high-quality studies of new agents are expected.
format Online
Article
Text
id pubmed-9720279
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-97202792022-12-06 A systematic review and network meta-analysis of the efficacy and safety of third-line and over third-line therapy after imatinib and TKI resistance in advanced gastrointestinal stromal tumor Xiao, Xianhao Yuan, Weiye Wang, Chong Song, He Front Pharmacol Pharmacology Tyrosine kinase inhibitors (TKIs) have greatly improved the prognosis of unresectable and metastatic gastrointestinal stromal tumors (GISTs) in the last two decades. Imatinib and sunitinib are recommended as first-line and second-line therapies, respectively. However, there is a lack of precision therapy for refractory GISTs regarding therapy after imatinib and sunitinib. We comprehensively searched electronic databases, including PubMed, EMBASE, Web of Science, Cochrane Library, and ClinicalTrials, from inception to October 2022. Randomized controlled trials featuring comparisons with third-line or over third-line therapies against GISTs were eligible. The primary outcome was progression-free survival (PFS). All network calculations were performed using random effect models, and the ranking of regimens were numerically based on the surface under the cumulative ranking (SUCRA) statistics. A total of seven studies were eligible for inclusion in this network meta-analysis. After analysis, ripretinib was ranked at the top in progression-free survival (PFS), overall survival (OS), and disease control rate (DCR) (SUCRA statistics: 83.1%, 82.5%, and 86.5%, respectively), whereas nilotinib and pimitespib presented better tolerability (SUCRA statistics: 64.9% and 63.8%, respectively). We found that regorafenib seemed more reliable for clinical administration, and ripretinib showed good effectiveness for the over third-line therapy. Precise targeted therapy is a critical direction for the future treatment of GIST, and more high-quality studies of new agents are expected. Frontiers Media S.A. 2022-11-21 /pmc/articles/PMC9720279/ /pubmed/36479203 http://dx.doi.org/10.3389/fphar.2022.978885 Text en Copyright © 2022 Xiao, Yuan, Wang and Song. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pharmacology
Xiao, Xianhao
Yuan, Weiye
Wang, Chong
Song, He
A systematic review and network meta-analysis of the efficacy and safety of third-line and over third-line therapy after imatinib and TKI resistance in advanced gastrointestinal stromal tumor
title A systematic review and network meta-analysis of the efficacy and safety of third-line and over third-line therapy after imatinib and TKI resistance in advanced gastrointestinal stromal tumor
title_full A systematic review and network meta-analysis of the efficacy and safety of third-line and over third-line therapy after imatinib and TKI resistance in advanced gastrointestinal stromal tumor
title_fullStr A systematic review and network meta-analysis of the efficacy and safety of third-line and over third-line therapy after imatinib and TKI resistance in advanced gastrointestinal stromal tumor
title_full_unstemmed A systematic review and network meta-analysis of the efficacy and safety of third-line and over third-line therapy after imatinib and TKI resistance in advanced gastrointestinal stromal tumor
title_short A systematic review and network meta-analysis of the efficacy and safety of third-line and over third-line therapy after imatinib and TKI resistance in advanced gastrointestinal stromal tumor
title_sort systematic review and network meta-analysis of the efficacy and safety of third-line and over third-line therapy after imatinib and tki resistance in advanced gastrointestinal stromal tumor
topic Pharmacology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9720279/
https://www.ncbi.nlm.nih.gov/pubmed/36479203
http://dx.doi.org/10.3389/fphar.2022.978885
work_keys_str_mv AT xiaoxianhao asystematicreviewandnetworkmetaanalysisoftheefficacyandsafetyofthirdlineandoverthirdlinetherapyafterimatinibandtkiresistanceinadvancedgastrointestinalstromaltumor
AT yuanweiye asystematicreviewandnetworkmetaanalysisoftheefficacyandsafetyofthirdlineandoverthirdlinetherapyafterimatinibandtkiresistanceinadvancedgastrointestinalstromaltumor
AT wangchong asystematicreviewandnetworkmetaanalysisoftheefficacyandsafetyofthirdlineandoverthirdlinetherapyafterimatinibandtkiresistanceinadvancedgastrointestinalstromaltumor
AT songhe asystematicreviewandnetworkmetaanalysisoftheefficacyandsafetyofthirdlineandoverthirdlinetherapyafterimatinibandtkiresistanceinadvancedgastrointestinalstromaltumor
AT xiaoxianhao systematicreviewandnetworkmetaanalysisoftheefficacyandsafetyofthirdlineandoverthirdlinetherapyafterimatinibandtkiresistanceinadvancedgastrointestinalstromaltumor
AT yuanweiye systematicreviewandnetworkmetaanalysisoftheefficacyandsafetyofthirdlineandoverthirdlinetherapyafterimatinibandtkiresistanceinadvancedgastrointestinalstromaltumor
AT wangchong systematicreviewandnetworkmetaanalysisoftheefficacyandsafetyofthirdlineandoverthirdlinetherapyafterimatinibandtkiresistanceinadvancedgastrointestinalstromaltumor
AT songhe systematicreviewandnetworkmetaanalysisoftheefficacyandsafetyofthirdlineandoverthirdlinetherapyafterimatinibandtkiresistanceinadvancedgastrointestinalstromaltumor