A framework for living evidence synthesis in cancer: Living, interactive network meta-analysis for first-line treatment of metastatic renal cell carcinoma (mRCC)

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Background: Systematic reviews are outdated quickly when the evidence is rapidly evolving as the process is laborious and there is little incentive for primary author team of an index SRMA to update the evidence. Consequently, there is an epidemic of redundant SRMAs performed by different teams—sometimes with conflicted results—for treatment of first line mRCC. Methods: We have created a living, interactive systematic review (LISR)and network meta-analysis(LINMA) for the treatment of first line mRCC using an Artificial intelligence (AI) assisted framework for evidence synthesis (Living, Interactive evidence synthesis framework) (LIvE) . The framework is implemented in five-layered architecture (application layer, shared module layer, core service layer, middleware layer, and storage layer) which work together to automate the identification of new studies and analysis and semi-automate the screening and data extraction. Dynamic features such as interactive tables, figures and evidence maps are enabled using Python and JavaScript programming languages. Results: We have maintained a living, interactive evidence profile for the first line treatment mRCC since September 2019 ( LIVING WEBSITE) . Living search strategy identifies new studies as they become available. As of October 13, 2020 LISR, includes data 14 clinical trials ( PRISMA ). Baseline characteristics are summarized in an interactive table ( TABLE) . Cabozantinib& Nivolumab (Cabo-Nivo) is the highest ranked drug for improving Overall Response (OR), Progression Free Survival (PFS) and Overall Survival (OS) whereas Ipilimumab in combination with Nivolumab (Ipi-Nivo) is highest ranked drug for achieving complete response (CR). Ipi-Nivo and Atezolizumab & Bevacizumab (Ate-Bev) ranked highest and Cabo-Nivo ranked lowest for treatment related Adverse events (TRAEs). Results of network meta-analysis are summarized as interactive tables and plots ( NMA ), summary of findings tables ( MULTIPLE COMAPRISONS ) and evidence maps ( MAP ). Conclusions: LISRs can potentially reduce redundancy, increase transparency, reproducibility, enable shared-decision making (at a guideline level, or in a patient-clinician dyad) and support living guidelines.

Treatment of metastatic castration sensitive prostate cancer (mCSPC) by disease volume: A systematic review and a meta-analysis

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Background: Chemotherapy with Docetaxel (D) or androgen pathway inhibition (API) with Abiraterone Acetate plus prednisone (AAP), Aplautamide(APA) and Enzalutamide(E) are acceptable, FDA approved treatment options for mCSPC. It is not clear whether the magnitude of benefit varies by the choice of initial agent [chemotherapy vs API] or by volume of disease [High vs Low]. Data is now available from all registration trials by volume status and motivated this analysis to inform initial treatment choice in mCSPC. Methods: We systematically searched MEDLINE(Ovid), Embase, and Scopus for randomized controlled trials of chemotherapy(D) or APIs (AAP, APA, ENZ) that had available hazard ratios (HRs) for overall survival (OS) and Progression Free Survival (PFS) according to patient’s volume of disease. We also reviewed abstracts and presentations from all major conference proceedings. We calculated the pooled overall survival HR and 95% CI by chemotherapy and APIs and by high volume(HVD) and low volume(LVD) using a random effect model, and tested for heterogeneity to assess the null hypothesis that no difference in the survival advantage exists by choice of initial agent and volume of disease. Results: Of 4456 studies identified in our search, there were 8 eligible randomized controlled trials that were included in the analysis. Both D and APIs significantly improved PFS [HR 0.48; 0.45-0.51] and OS [0.72; 0.64-0.81] when added to ADT, however the latter was associated with significantly higher improvement in PFS( P < 0.01) and OS (P = 0.03). In patients treated with D, patients with HVD derive significantly more benefit as compared to LVD( P = 0.046) and patients treated with APIs both HVD and LVD patients derive similar benefit( P = 0.80) (Table). Conclusions: mCSPC patients derive higher magnitude of survival benefit when treated with APIs as compared to D; however, D may be preferred in HVD patients. [Table: see text]

Fabrication of High Efficiency Dye-Sensitised Solar Cell with Zirconia-Doped TiO2 Nanoparticle and Nanowire Composite Photoanode Film

Dye-sensitised solar cells (DSSCs) were fabricated based on coumarin NKX-2700 dye-sensitised zirconia-doped TiO2 nanoparticle and nanowire composite photoanode film and quasi-solid-state electrolyte, sandwiched together with cobalt sulfide-coated counter electrode. Novel photoanodes were prepared using composite mixtures of 90 wt-% TiO2 nanoparticles + 10 wt-% TiO2 nanowires (TNPWs) as base material and zirconia as doping metal. Hafnium oxide (HfO2) was applied on the zirconia-doped TNPWs (zirconia/TNPWs) film structure as a blocking layer. TiO2 nanoparticles, TiO2 nanowires, and zirconia/TNPWs were characterised by X-ray diffraction, scanning electron microscopy, and transmission electron microscopy. The sensitising organic dye coumarin, NKX-2700, displayed maximum absorption wavelength (λmax) at 525 nm, which could be observed from the UV-visible spectrum. DSSC-1 built with zirconia/TNPWs-doped photoanode with blocking layer revealed enhanced photo-current efficiency (PCE) as compared with other DSSCs and illustrated photovoltaic parameters: short circuit current JSC = 20 mA m–2, open circuit voltage (VOC = 730 mV, fill factor (FF) = 68 %, and PCE (η) = 9.93 %. The electron transport and charge recombination behaviours of DSSCs were investigated by electrochemical impedance spectroscopy and the results exhibited that DSSC-1 possessed the lowest charge transfer resistance (Rrec) and longest electron lifetime (τrec) compared with other DSSCs. Therefore, from the present investigation, it could be concluded that the improved performance of DSSC-1 is ascribed to the zirconia/TNPWs-doped photoanode with the blocking layer increasing the short circuit current, electron transport, and suppressing the recombination of charge carriers at the photoanode/dye/electrolyte interface.