The following is a summary of “A network meta-analysis evaluating the efficacy and safety of adjuvant therapy after nephrectomy in renal cell carcinoma,” published in the March 2024 issue of Urology by Guo et al.
In recent years, there has been a concerning surge in the incidence of renal cell carcinoma (RCC), with RCC recurrence emerging as a leading cause of mortality. Despite extensive clinical investigations, the precise impact of various medications on the long-term survival of post-nephrectomy RCC patients remains uncertain. This network meta-analysis was conducted to comprehensively evaluate different medications’ efficacy and safety profiles in individuals with RCC following nephrectomy.
Methodologically, a meticulous search was conducted across several databases, including CNKI, WAN FANG DATA, VIP, Web of Science, Cochrane Library (CENTRAL), PubMed, Scopus, and Embase, encompassing articles published up to June 2, 2023. The meta-analysis primarily focused on randomized controlled trials (RCTs) to ensure the robustness and reliability of the findings.
The comprehensive analysis incorporated 17 studies involving a total of 14,298 participants. Results from the disease-free survival (DFS) analysis revealed that pembrolizumab exhibited notable efficacy in augmenting DFS among RCC patients post-nephrectomy, showcasing a favorable hazard ratio (HR) of 0.83 (95%CI 0.70 to 0.99) compared to the placebo group. However, none of the medications investigated significantly improved overall survival (OS) and recurrence-free survival (RFS) post-nephrectomy. Notably, adverse event (AE) analysis highlighted a higher incidence of adverse events associated with sorafenib, pazopanib, sunitinib, and nivolumab plus ipilimumab interventions than placebo.
In conclusion, the network meta-analysis underscores compelling evidence suggesting that pembrolizumab may hold promise in enhancing DFS among post-nephrectomy RCC patients, outperforming the efficacy observed with a placebo. However, further research is warranted to elucidate the optimal therapeutic strategies and to address the existing uncertainties surrounding the long-term management of RCC post-nephrectomy.
Source: bmcurol.biomedcentral.com/articles/10.1186/s12894-024-01441-8