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Review
. 2020 Feb 13;15(1):51.
doi: 10.1186/s13018-020-1576-0.

The efficacy and safety comparison of first-line chemotherapeutic agents (high-dose methotrexate, doxorubicin, cisplatin, and ifosfamide) for osteosarcoma: a network meta-analysis

Bin Zhang  1 , Yan Zhang  2 , Rongzhen Li  3 , Jiazhen Li  1 , Xinchang Lu  1 , Yi Zhang  1
Affiliations
Review

The efficacy and safety comparison of first-line chemotherapeutic agents (high-dose methotrexate, doxorubicin, cisplatin, and ifosfamide) for osteosarcoma: a network meta-analysis

Bin Zhang et al. J Orthop Surg Res. .

Abstract

Background: Osteosarcoma, a primary malignant bone tumor derived from mesenchymal tissue, is the most common type of pleomorphic tumor that occurs in children and adolescents. The aim of this study was to compare the efficacy and safety of high-dose methotrexate (M), doxorubicin (D), cisplatin (C), and ifosfamide (I) in the management of osteosarcoma.

Methods: Electronic databases including PubMed, Cochrane Library, and Embase database were searched for studies published from when the databases were established to July 13, 2019. The network meta-analysis was performed using software R 3.3.2 and STATA version 41.0 after demographic and outcome data extraction. The ranks based on probabilities of interventions for each outcome were performed. In addition, the consistency of direct and indirect evidence was assessed by node splitting.

Results: The network meta-analysis results revealed that MDCI had a significant lower hazard risk of overall survival [MDCI vs MDC: HR = 0.74, 95% CrI (0.23, 0.87); MDCI vs DC: HR = 0.60, 95% CrI (0.16, 0.92)]. In addition, MDCI had a clearly longer progression-free survival time than that of DC [MDCI: HR = 0.88, 95% CrI (0.46, 0.98)]. No significant difference was detected in MDC and DC in OS, PFS, and AEs. The probabilities of rank plot showed that MDCI ranked first in OS (73.12%) and PFS (52.43%). DC was the best treatment in safety, ranked first (75.43%).

Conclusions: MDCI showed its superiority among all chemotherapeutic agents in relation to efficacy and safety, followed by MDC. In addition, MDCI was associated with an increased risk of AEs. According to our analysis, DC was less effective but safer for MDC and MDCI.

Keywords: Chemotherapy; Cisplatin; Doxorubicin; Ifosfamide; Methotrexate; Network meta-analysis; Osteosarcoma.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of the study selection process for the network meta-analysis
Fig. 2
Fig. 2
Risk of bias: graph and summary of the included studies. a Reviewers’ judgments of each risk of bias item for eligible studies. b The judgments of each item of risk of bias, presented as percentages across all eligible studies
Fig. 3
Fig. 3
Network geometry of three chemotherapy regimens
Fig. 4
Fig. 4
The relevant rank plots based on probabilities of interventions. a Overall survival. b Progression-free survival. c Total severe adverse events
See this image and copyright information in PMC

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