Risks and benefits of anticancer drugs in advanced cancer patients: A systematic review and meta-analysis

Abstract

Background: Randomized clinical trials (RCTs) of anticancer drugs without active comparators in patients who have exhausted standard of care treatment options are debated. We aimed to quantify the safety and the efficacy of anticancer drugs in advanced cancer patients who have exhausted standard of care treatments from RCTs without active comparators. Methods: This systematic review and meta-analysis was conducted according to preferred reporting Items for systematic review and Meta-Analyses (PRISMA) guidelines (CRD42021243968). A systematic literature search of English language publications from January 1, 2000, to January 7, 2021, was performed using MED-LINE (PubMed). Eligible trials included all RCTs evaluating anticancer drugs in adult patients with advanced solid tumors with a control arm without any anticancer drug consisting of best supportive care with or without a placebo. RCTs performed in the adjuvant, neoadjuvant or maintenance settings were excluded, as were clinical trials evaluating anticancer drugs in combination with radiotherapy. Two authors (C.M.B. and E.C.) independently reviewed the studies for inclusion. Data from published reports were extracted by investigators, and random-effects meta-analysis was performed to estimate the overall hazard ratios (HRs) of progression-free survival (PFS) and overall survival (OS). Correlations between severe toxicity and efficacy was assessed using R 2 measures. Findings: Of 3551 studies screened, 128 eligible trials were found involving 47,432 patients. The HRs for PFS and OS were 0¢58 [95%CI: 0¢53À0¢63] and 0¢82 [95%CI: 0¢78À0¢85]. The absolute benefits however were limited with PFS and OS gains of 2¢1 and 0¢5 months. The absolute excesses in all grade, severe grade III, IV and V (death) adverse events between the two arms were +13¢9%, 10¢2%, and +0¢5%. A weak correlation was measured between the excess of severe toxicity and efficacy (all R 2 < 0¢2). Interpretation: Anticancer drugs evaluated in RCTs against no active treatment benefited trial participants. Severe toxicity did not significantly correlate with efficacy.

Assessment of patients’ preferences for new anticancer drugs in China: a best–worst discrete choice experiment on three common cancer types

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Engineering the Morphostructural Properties and Drug Loading Degree of Organic–Inorganic Fluorouracil–MgAl LDH Nanohybrids by Rational Control of Hydrothermal Treatment

“…Chemotherapy is the main strategy in the fight against cancer, especially for patients who are not eligible for local treatments, such as surgery and/or radiotherapy . However, the therapeutic effect is often limited by the resistance mechanisms developed by the host against the drug, while the treatment itself is accompanied by side effects due to the systemic exposure.…”

“…Chemotherapy is the main strategy in the fight against cancer, especially for patients who are not eligible for local treatments, such as surgery and/or radiotherapy. 1 However, the therapeutic effect is often limited by the resistance mechanisms developed by the host against the drug, while the treatment itself is accompanied by side effects due to the systemic exposure. In addition, certain drugs can be chemically changed upon contact with body fluids or are incapable to cross the biological barriers, both situations considerably decreasing the on-target therapeutic effect.…”

Thirteen Nonpharmacological Interventions for Increasing the Quality of Life in Patients with Advanced Cancer

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“…Anticancer drugs represent the main therapeutic strategy in this latter setting. 5 At present, the most common anticancer drugs include chemotherapy drugs, traditional Chinese medicine, biopharmaceuticals, and targeted drugs. When patients with advanced cancer are treated with anticancer drugs, the cure rate is relatively rare.…”