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Live cumulative network meta-analysis: protocol for second-line treatments in advanced non-small-cell lung cancer
Perrine Créquit1, Ludovic Trinquart2, Philippe Ravaud3
1Centre de Recherche Epidémiologie et Statistique Paris Sorbonne Cité, INSERM U1153, Paris, France Université Paris Descartes-Sorbonne Paris cité, Paris, France.
Introduction:
Many second-line treatments for advanced non-small-cell lung cancer (NSCLC) have been assessed in randomised controlled trials, but which treatments work the best remains unclear. Novel treatments are being rapidly developed. We need a comprehensive up-to-date evidence synthesis of all these treatments. We present the protocol for a live cumulative network meta-analysis (NMA) to address this need.
Methods And Analysis:
We will consider trials of second-line treatments in patients with advanced NSCLC with wild-type or unknown epidermal growth factor receptor status. We will consider any single agent of cytotoxic chemotherapy, targeted therapy, combination of cytotoxic chemotherapy and targeted therapy and any combination of targeted therapies. The primary outcomes will be overall survival and progression-free survival. The live cumulative NMA will be initiated with a NMA and then iterations will be repeated at regular intervals to keep the NMA up-to-date over time. We have defined the update frequency as 4 months, based on an assessment of the pace of evidence production on this topic. Each iteration will consist of six methodological steps: adaptive search for treatments and trials, screening of reports and selection of trials, data extraction, assessment of risk of bias, update of the network of trials and synthesis, and dissemination. We will set up a research community in lung cancer, with different groups of contributors of different skills. We will distribute tasks through online crowdsourcing. This proof-of-concept study in second-line treatments of advanced NSCLC will allow one for assessing the feasibility of live cumulative NMA and opening the path for this new form of synthesis.
Ethics And Dissemination:
Ethical approval is not required because our study will not include confidential participant data and interventions. The description of all the steps and the results of this live cumulative NMA will be available online.
Trial Registration Number:
CRD42015017592.
Insights
This study outlines a live cumulative network meta-analysis (NMA) for advanced non-small-cell lung cancer (NSCLC) second-line treatments. It aims to provide an up-to-date synthesis of novel and existing therapies to clarify treatment efficacy.
Area of Science:
- Oncology
- Clinical Trials
- Evidence Synthesis
Background:
- Numerous second-line treatments for advanced non-small-cell lung cancer (NSCLC) exist, yet comparative efficacy remains unclear.
- Rapid development of novel therapies necessitates continuous evidence updates.
- Existing meta-analyses may not reflect the latest treatment advancements in advanced NSCLC.
Purpose of the Study:
- To present the protocol for a live cumulative network meta-analysis (NMA) for second-line treatments in advanced NSCLC.
- To provide a comprehensive and up-to-date evidence synthesis of available and novel therapies.
- To address the need for clarity on the comparative effectiveness of different treatment options.
Main Methods:
- Inclusion of randomized controlled trials (RCTs) of second-line treatments for advanced NSCLC (wild-type or unknown EGFR status).
- Consideration of cytotoxic chemotherapy, targeted therapy, and combinations thereof.
- Live cumulative NMA updated every 4 months, involving adaptive search, screening, data extraction, risk of bias assessment, and synthesis via crowdsourcing.
Main Results:
- This section will report the findings from the live cumulative NMA as it is updated.
- The primary outcomes to be assessed are overall survival and progression-free survival.
- The study will provide comparative effectiveness data for various second-line treatments.
Conclusions:
- This proof-of-concept study aims to assess the feasibility of live cumulative NMA in advanced NSCLC.
- The methodology is designed to provide a dynamic and continuously updated evidence base.
- Successful implementation will pave the way for this novel synthesis method in other rapidly evolving fields.
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