Summary of findings 12. Sunitinib compared to atezolizumab (targeted therapy versus immunotherapy).
| Patient or population: Treatment‐naïve metastatic renal cell carcinoma (clear cell type) Setting: Multinational muticentre/likely outpatient Intervention: Sunitinib Comparison: Atezolizumab | |||||
| Outcomes | № of participants (studies) | Certainty of the evidence (GRADE) | Relative effect (95% CI) | Anticipated absolute effects* (95% CI) | |
| Risk with Atezolizumab | Risk difference with Sunitinib | ||||
|
Progression‐free survival (absolute effect size estimates based on survival rate at 12 months) follow‐up: median 20.7 months |
204 (1 RCT) | ⊕⊝⊝⊝ VERY LOW 1 2 | HR 0.84 (0.58 to 1.22) | Study population | |
| 420 per 1000 | 63 more per 1000 (73 fewer to 185 more) | ||||
|
Overall survival (absolute effect size estimates based on survival rate at 24 months) follow‐up: median 20.7 months |
204 (1 RCT) | ⊕⊝⊝⊝ VERY LOW 1 3 | HR 0.94 (0.58 to 1.54) | Moderate | |
| 630 per 1000 6 | 18 more per 1000 (139 fewer to 135 more) | ||||
| Serious adverse events (Grade 3 or 4) assessed with: CTCAE v4.0 | 203 (1 RCT) | ⊕⊕⊕⊝ MODERATE 2 | RR 1.73 (1.32 to 2.27) | Study population | |
| 398 per 1000 | 291 more per 1000 (127 more to 506 more) | ||||
| Health‐related quality of life assessed with: MDASI (high score indicates worse QoL) Scale from: 0 to 10 follow‐up: 12 weeks | 157 (1 RCT) | ⊕⊕⊝⊝ LOW 4 5 | ‐ | The mean health‐related quality of life was 1.04 | MD 1.46 higher (0.8 higher to 2.12 higher) |
| *The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; CTCAE: Common Terminology Criteria for Adverse Events;HR: Hazard ratio; MDASI: MD Anderson Symptom Inventory; RCT: Randomized controlled trial; RR: Risk ratio | |||||
| GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | |||||
1 Downgraded by 2 levels for imprecision; confidence interval crossed the line of no difference and the assumed threshold of a clinically important difference: wide confidence interval (included both benefit and harm)
2 Downgraded by 1 level for study limitations; high risk of selection, performance and detection bias and unclear risk of other bias
3 Downgraded by 1 level for study limitations; high risk of selection and unclear risk of other bias
4 Downgraded by 1 level for imprecision; confidence interval crossed the assumed threshold of a clinically important difference (1 point, included harm and little harm)
5 Downgraded by 1 level for study limitations; high risk of selection, performance and detection bias and unclear risk of other bias
6 Baseline risk for overall survival in the atezolizumab group was assumed to be 63% (moderate risk) at 24 months as reported in Rini 2019b