Abstract P3-09-02: Optimal anti-emetic choice for breast cancer patients receiving anthracycline and cyclophosphamide-based chemotherapy - A systematic review and network meta-analysis of randomized controlled trials
Notice bibliographique
Résumé
Abstract Background: International expert consensus groups such as ASCO (JCO 2011) and MASCC (Ann of Oncol. 2010) recommend that patients (pts) receiving anthracycline and cyclophosphamide-based chemotherapy (A&C-CT) regimens receive an anti-emetic combination of 5HT3 antagonist (day 1), NK1 receptor antagonist (day/s 1 or 1-3), and dexamethasone (days 1-3/4). Clinical experience would suggest that Total Control (no episodes of chemotherapy-induced nausea and vomiting [CINV] and no rescue anti-emetic use for 5 days after CT) is often not achieved. We therefore sought to use Network meta-analysis (NMA) to provide a quantitative summary of existing randomised controlled trials (RCTs) to identify the optimal anti-emetic regimen for these pts. Methods: A peer reviewed search of RCTs assessing combination anti-emetic regimens in breast cancer pts on A&C-CT was performed using Medline, Embase and Cochrane CENTRAL. No additional restriction criteria were employed. Two individuals independently screened citations and full text articles to identify eligible RCTs. Pt and study characteristics, as well as, outcome data were collected to ensure studies were sufficiently similar to include in the NMA. The primary outcome was Total Control of CINV (no nausea, no vomiting, and no rescue anti-emetics for 5 days). Secondary outcomes included Complete Response (no vomiting and no rescue medications for 5 days), No Vomiting and No Nausea in the acute (0-24 hrs) and delayed (24-120 hrs) periods, respectively. Results: From 962 citations identified, 152 were retained after abstract screening, and 20 retained after full-text screening. Trials were published from 1990 to 2012. There was limited reporting of pt characteristics and CINV outcomes beyond the first CT cycle. The majority of comparisons in the network of treatments were supported by only one RCT. The significant heterogeneity in anti-emetic regimens (n = 21) mandated combining treatment doses and durations to make NMA feasible. Six out of 20 studies reported Total Control, occurring in a mean proportion of 26.9% (23 - 65%) of pts. Complete Response was reported in 11/18 trials, occurring in a mean of 49.8% (31.2% - 79.3%) of pts. Conclusions: Clinical experience suggests that despite best practice recommendations, many pts do not achieve Total Control of CINV. In preparing for a NMA, we identified marked heterogeneity between trials. This included variability in study design, sample size, treatment agents, duration of agents used, and in reporting of pt characteristics and outcome measures. Given these limitations, despite the recommendations of consensus groups, we have yet been able to make any firm decision on the optimal anti-emetic regimen based on the evidence at this time. We will present findings from our NMA, which will try to account for these limitations. However, if anti-emetic care is to be improved future pragmatic RCTs that include both nausea and vomiting outcomes are clearly required. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-09-02.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,034 | 0,010 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,043 | 0,006 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; les deux têtes enseignantes s’accordent sur ce qui est montré ici.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».