BACKGROUND Second-line treatment for urothelial carcinoma (UC) patients is used if progression or failure after platinum-based chemotherapy occurs or if patients are cisplatin-unfit. However, there is still no widely accepted treatment strategy. We aimed to analyze the effectiveness and safety of second-line treatment strategies for UC patients. METHODS The PubMed, Embase, and Cochrane databases were searched for randomized controlled trials (RCTs) that included UC patients who were cisplatin-ineligible or unfit up to April 19, 2019. The primary outcomes were progression-free survival (PFS), overall survival (OS), and objective response rate (ORR). RESULTS Thirteen trials that assessed 3502 UC patients were included. This study divided the network comparisons into three parts. The first part contained studies comparing taxanes and other interventions; the second part assessed investigator's choice chemotherapy (ICC)-related comparisons; and the third part assessed best support care (BSC). In the OS results of the first part, pembrolizumab (87.5%), ramucirumab plus docetaxel (74.6%), and atezolizumab (71.1%) had a relative advantage. Pembrolizumab also had advantages in ORR and severe adverse effect (SAE) results. Vinflunine and ramucirumab plus docetaxel had a relatively high surface under the cumulative ranking curve (SUCRA) rank by exploratory cluster analysis. CONCLUSIONS This study concluded that atezolizumab and pembrolizumab are superior to other treatments, mainly in OS results, but no treatment confers a significant advantage in PFS. Pembrolizumab still has relative advantages in ORR and SAE results compared to ICC. Due to limitations, more studies are necessary to confirm the conclusions.

中文翻译：

---

进展性或不适合顺铂治疗的尿路上皮癌患者的二线治疗策略：网络荟萃分析。

背景技术如果铂类化学疗法发生后进展或衰竭，或者患者患有顺铂不适应症，则使用尿路上皮癌（UC）患者的二线治疗。但是，仍然没有被广泛接受的治疗策略。我们旨在分析针对UC患者的二线治疗策略的有效性和安全性。方法在PubMed，Embase和Cochrane数据库中搜索随机对照试验（RCT），其中包括截至2019年4月19日不符合顺铂治疗或不适合UC的UC患者。主要结局为无进展生存期（PFS），总生存期（OS）和客观反应率（ORR）。结果纳入了评估3502例UC患者的13项试验。这项研究将网络比较分为三个部分。第一部分包含比较紫杉烷和其他干预措施的研究。第二部分评估了研究者选择化疗（ICC）的相关比较；第三部分评估了最佳支持护理（BSC）。在第一部分的OS结果中，派姆单抗（87.5％），雷莫西单抗加多西他赛（74.6％）和阿托珠单抗（71.1％）具有相对优势。派姆单抗在ORR和严重不良反应（SAE）结果方面也具有优势。通过探索性聚类分析，长春氟宁和雷莫昔单抗加多西他赛在累积等级曲线（SUCRA）等级下具有相对较高的表面。结论本研究得出结论，阿泰珠单抗和派姆单抗在其他方面优于其他治疗，主要是在OS方面，但没有一种治疗在PFS中具有显着优势。与ICC相比，Pembrolizumab在ORR和SAE结果方面仍具有相对优势。由于局限性，需要更多的研究来证实结论。