| Quality assessment | No of patients | Effect | Quality | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| No of studies | Design | Risk of bias | Inconsistency | Indirectness | Imprecision | Other considerations | Ifosfamide | Control | Relative (95% CI) | Absolute | |
| Overall survival | |||||||||||
| 21 | observational studies | none | none | none | serious2 | none | N=86 | - | Median OS = 8 and 5.5 months | ⊕○○○ VERY LOW | |
| Progression-free survival | |||||||||||
| 21 | observational studies | none | none | none | serious2 | none | N=86 | - | Median PFS = 6 and 2.5 months | ⊕○○○ VERY LOW | |
| Overall tumour response (assessed with: ECOG/WHO criteria) | |||||||||||
| 21 | observational studies | none | none | none | serious2 | none | 12/76 (15.8%) | - | - | - | ⊕○○○ VERY LOW |
| Grade 3-4 Neutropenia | |||||||||||
| 0 | No evidence available | ||||||||||
| Grade 3-4 Thrombocytopenia (assessed with: NCI-CTC) | |||||||||||
| 13 | observational studies | none | none | none | serious2 | none | 12/56 (21.4%) | - | - | - | ⊕○○○ VERY LOW |
| Grade 3-4 Anaemia (assessed with: NCI-CTC) | |||||||||||
| 12 | observational studies | none | none | none | serious2 | none | 23/56 (41.1%) | - | - | - | ⊕○○○ VERY LOW |
| Grade 3-4 Leucopenia | |||||||||||
| 12 | observational studies | none | none | none | serious2 | none | 36/56 (64.3%) | - | - | - | ⊕○○○ VERY LOW |
| Treatment-related mortality | |||||||||||
| 21 | observational studies | none | none | none | serious2 | none | 4/76 (5.3%)4 | - | - | - | ⊕○○○ VERY LOW |
| Health-related quality of life | |||||||||||
| 0 | No evidence available | ||||||||||
Small sample size/low number of events limits the precision of this outcome
Witte 1997 (no grade 3-4 hematologic toxicities were reported by Pronzato (1997) which may be due to differences in the dosing schedule of Ifosfamide used, therefore toxicity data was not pooled);
Four early deaths were reported by Witte 1997, which although could not be directly linked to treatment, it was assumed treatment was a contributing factor
From: 5, Managing locally advanced or metastatic bladder cancer
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