TY - JOUR
T1 - Therapeutic interventions for childhood cancer
T2 - An umbrella review of randomized evidence
AU - Lavasidis, Georgios
AU - Markozannes, Georgios
AU - Panagiotou, Orestis A.
AU - Trikalinos, Nikolaos A.
AU - Petridou, Eleni Th
AU - Voorhies, Kirsten
AU - Ntzani, Evangelia E.
N1 - Funding Information:
Dr. Panagiotou and Ms. Voorhies were supported by grant 1 R03 HS025840 01A1 from the Agency of Healthcare Research and Quality.Dr. Panagiotou reports grants from the National Institutes of Health and the Agency of Healthcare Research and Quality.Dr. Panagiotou reports personal fees from International Consulting Associates, Inc.outside the scope of the submitted work.
Funding Information:
Dr. Panagiotou reports grants from the National Institutes of Health and the Agency of Healthcare Research and Quality.
Publisher Copyright:
© 2021 Elsevier B.V.
PY - 2021/8
Y1 - 2021/8
N2 - Treatment advancements in pediatric cancer have improved prognosis, but the strength of supporting evidence has not been thoroughly evaluated. To critically appraise it, we performed an umbrella review of meta-analyses of randomized controlled trials examining the efficacy and safety of therapeutic interventions for pediatric malignancies. Fourteen publications (68 meta-analyses, 31,496 participants) were eligible. Acute lymphoblastic leukemia (ALL) was investigated at most. Substantial heterogeneity was detected in 10 associations, with limited indications for small-study effects and excess-significance bias. The most concrete evidence pertained to the use of methotrexate and vincristine-prednisone pulses for ALL, improving event-free survival. Evidence regarding other cancers was relatively weak. Conclusively, we found few small meta-analyses focusing mainly on ALL. Randomized evidence stemming from adult populations still seems to serve as valuable indirect evidence backup. More randomized evidence and individual patient data meta-analyses are needed to increase certainty and precision in the care of pediatric cancer patients.
AB - Treatment advancements in pediatric cancer have improved prognosis, but the strength of supporting evidence has not been thoroughly evaluated. To critically appraise it, we performed an umbrella review of meta-analyses of randomized controlled trials examining the efficacy and safety of therapeutic interventions for pediatric malignancies. Fourteen publications (68 meta-analyses, 31,496 participants) were eligible. Acute lymphoblastic leukemia (ALL) was investigated at most. Substantial heterogeneity was detected in 10 associations, with limited indications for small-study effects and excess-significance bias. The most concrete evidence pertained to the use of methotrexate and vincristine-prednisone pulses for ALL, improving event-free survival. Evidence regarding other cancers was relatively weak. Conclusively, we found few small meta-analyses focusing mainly on ALL. Randomized evidence stemming from adult populations still seems to serve as valuable indirect evidence backup. More randomized evidence and individual patient data meta-analyses are needed to increase certainty and precision in the care of pediatric cancer patients.
KW - Childhood cancer
KW - Leukemia
KW - Randomized controlled trials
KW - Survival
KW - Therapeutic interventions
KW - Umbrella review
UR - http://www.scopus.com/inward/record.url?scp=85110568777&partnerID=8YFLogxK
U2 - 10.1016/j.critrevonc.2021.103414
DO - 10.1016/j.critrevonc.2021.103414
M3 - Review article
C2 - 34242770
AN - SCOPUS:85110568777
SN - 1040-8428
VL - 164
JO - Critical Reviews in Oncology/Hematology
JF - Critical Reviews in Oncology/Hematology
M1 - 103414
ER -