The Use of (Network) Meta-Analysis in Clinical Oncology

Meta-analysis is important in oncological research to provide a more reliable answer to a clinical research question that was assessed in multiple studies but with inconsistent results. Pair-wise meta-analysis can be applied when comparing two treatments at once, whereas it is possible to compare multiple treatments at once with network meta-analysis (NMA). After careful systematic review of the literature and quality assessment of the identified studies, the added value of meta-analysis should be evaluated first by examining the comparability of study populations. Second, the appropriate comparator in meta-analysis should be chosen according to the types of comparisons made in individual studies: 1. Experimental and comparator arms are different treatments (A vs B); 2. Substitution of a conventional treatment by an experimental treatment (A+B vs A+C); or 3. Addition of an experimental treatment (A+B vs B). Ideally there is one common comparator treatment, but when there are multiple common comparators, the most efficacious comparator is preferable. Third, treatments can only be adequately pooled in meta-analysis or merged into one treatment node in NMA when considering likewise mechanism of action and similar setting for which treatment is indicated. To evaluate heterogeneity in both pair-wise meta-analysis and NMA, sub-analysis and sensitivity analysis can be applied to objectify a possible confounding factor. Network inconsistency in NMA can best be evaluated by node-s...
Source: Frontiers in Oncology - Category: Cancer & Oncology Source Type: research