Do patients with soft-tissue sarcomas treated with trabectedin have better clinical effects and a longer survival time than those treated with doxorubicin?
We read with great interest the recent published study by Dang and colleagues entitled “Comparison between trabectedin and doxorubicin in soft-tissue sarcomas (STS): a systematic review and meta-analysis” (1). They demonstrated that STS patients treated with trabectedin had better clinical effects and a longer survival time than those who treated with doxorubicin. We appreciate Dang and colleagues for the valuable study. However, after a careful learning of the literature, we would like to pay attention to some important missing aspects in the study.
Firstly, after carefully reviewing the included study by Hartmann et al. (2), we found that 120 patients diagnosed as STS were randomly divided into two groups: arm A group (doxorubicin for 6 cycles) and arm B group (oral trofosfamide) and each group with 40 and 80 patients. Whereas, in Table 1, Dang et al. depicted that 80 patients were included, which was not consistent with the original study (2). Moreover, the erroneous data that disease control rate of 54 cases in 75 patients in experimental group and disease control rate of 41 cases in 39 patients in control group resulted in odds ratio (OR) was not being estimable showed in Figure 6.
Secondly, sensitivity analysis is carried out by omitting one study at a time to investigate the effect on the overall pooled estimate (3). In the heterogeneity investigation and sensitivity analyses section, the authors performed the sensitivity analysis only by omitting Schöffski et al.’s study (4) and did not further exclude the other included studies. Hence, we believe that the sensitivity analysis was insufficient.
In short, Dang et al. revealed a significant issue with regard to the comparison of clinical effects and survival time between trabectedin and doxorubicin in STS. However, the data should be further revised to validate the conclusions because of the concerns above.
Acknowledgments
Funding: None.
Footnote
Provenance and Peer Review: This article was a standard submission to the journal. The article did not undergo external peer review.
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://atm.amegroups.com/article/view/10.21037/atm-21-7018/coif). The authors have no conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
References
- Dang J, Fu J, Zhang Z, et al. Comparison between trabectedin and doxorubicin in soft-tissue sarcomas: a systematic review and meta-analysis. Ann Transl Med 2021;9:1764. [Crossref] [PubMed]
- Hartmann JT, Kopp HG, Gruenwald V, et al. Randomised phase II trial of trofosfamide vs. doxorubicin in elderly patients with untreated metastatic soft-tissue sarcoma. Eur J Cancer 2020;124:152-60. [Crossref] [PubMed]
- Wu J, Wang Y, Zhao A, et al. Lung Ultrasound for the Diagnosis of Neonatal Respiratory Distress Syndrome: A Meta-analysis. Ultrasound Q 2020;36:102-10. [Crossref] [PubMed]
- Schöffski P, Toulmonde M, Estival A, et al. Randomised phase 2 study comparing the efficacy and safety of the oral tyrosine kinase inhibitor nintedanib with single agent ifosfamide in patients with advanced, inoperable, metastatic soft tissue sarcoma after failure of first-line chemotherapy: EORTC-1506-STBSG "ANITA". Eur J Cancer 2021;152:26-40. [Crossref] [PubMed]
