Comparative Efficacy and Safety of Immunotherapy on Non–Small Cell Lung Cancer Patients With Brain Metastases: A Systematic Review and Network Meta-Analysis

IF 1.9 4区医学 Q3 RESPIRATORY SYSTEM

Clinical Respiratory Journal Pub Date : 2024-08-20 DOI:10.1111/crj.13823

Tianyi Lyu, Bo Sun, Daowen Yang, Xirui Zhao, Ruoshui Wang, Xinyang Shu, Demin Li, Hong Chen

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引用次数: 0

Abstract

Background

Growing evidence suggests that immunotherapy has a positive effect on non–small cell lung cancer (NSCLC) patients with brain metastases (BMs). However, it remains unclear which type of immunotherapy is more efficient. The aim of this network meta-analysis (NMA) was to compare the efficacy and safety of different immunotherapy types and determine the optimal option.

Method

Four databases (PubMed, Cochrane Library databases, Embase, and Web of Science) and ClinicalTrial.gov were searched from inception until January 26, 2023. Randomized controlled trials (RCTs), prospective nonrandomized trials, or observational studies investigating NSCLC patients with BMs treated by immunotherapy were included. The quality of the included studies was evaluated using the Cochrane risk of bias (ROB) tool and the Newcastle-Ottawa Scale (NOS). The efficacy of immunotherapy on NSCLC patients with BMs was evaluated using frequentist random-effects NMA.

Result

Eleven studies from 1560 citations, encompassing 1437 participants, were included in this NMA. Statistical analysis showed that pembrolizumab (SMD = 4.35, 95% CI [2.21, 6.60]) and nivolumab+ipilimumab (SMD = 3.81, 95% CI [1.21, 6.40]) could improve overall survival (OS). Pembrolizumab (SMD = 3.32, 95% CI [2.75, 3.90]) demonstrated better effects in improving the overall response rate (ORR). No significant difference in adverse event (AE) was observed between immunotherapy and chemotherapy.

Conclusion

Our findings indicated that pembrolizumab was the most promising immunotherapy for NSCLC patients with BMs. Nivolumab+ipilimumab might be an alternative choice to improve OS.

Limitation

Inconsistency tests were not performed because of the scarcity of direct comparison. Besides, high heterogeneity was observed in our NMA.

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查看原文本刊更多论文

免疫疗法对非小细胞肺癌脑转移患者的疗效和安全性比较：系统综述与网络元分析》。

背景：越来越多的证据表明，免疫疗法对患有脑转移（BMs）的非小细胞肺癌（NSCLC）患者有积极作用。然而，目前仍不清楚哪种免疫疗法更有效。本网络荟萃分析（NMA）旨在比较不同类型免疫疗法的疗效和安全性，并确定最佳方案：方法：对四个数据库（PubMed、Cochrane Library 数据库、Embase 和 Web of Science）和 ClinicalTrial.gov 进行了检索，检索时间从开始到 2023 年 1 月 26 日。纳入的研究包括随机对照试验（RCT）、前瞻性非随机试验或观察性研究，这些研究调查了接受免疫疗法治疗的NSCLC骨髓瘤患者。采用科克伦偏倚风险（ROB）工具和纽卡斯尔-渥太华量表（NOS）对纳入研究的质量进行了评估。使用频数随机效应NMA评估了免疫疗法对患有BMs的NSCLC患者的疗效：该NMA纳入了来自1560篇引用文献的11项研究，涉及1437名参与者。统计分析显示，pembrolizumab（SMD = 4.35，95% CI [2.21，6.60]）和 nivolumab+ipilimumab （SMD = 3.81，95% CI [1.21，6.40]）可改善总生存期（OS）。Pembrolizumab（SMD = 3.32，95% CI [2.75，3.90]）在提高总体应答率（ORR）方面表现出更好的效果。免疫疗法与化疗在不良反应（AE）方面无明显差异：我们的研究结果表明，pembrolizumab是治疗NSCLC骨髓瘤患者最有前景的免疫疗法。局限性：未进行一致性检验：局限性：由于缺乏直接比较，因此没有进行不一致性测试。此外，我们的NMA观察到了高度异质性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Respiratory Journal 医学-呼吸系统

CiteScore

3.70

自引率

0.00%

发文量

104

审稿时长

>12 weeks

期刊介绍： Overview Effective with the 2016 volume, this journal will be published in an online-only format. Aims and Scope The Clinical Respiratory Journal (CRJ) provides a forum for clinical research in all areas of respiratory medicine from clinical lung disease to basic research relevant to the clinic. We publish original research, review articles, case studies, editorials and book reviews in all areas of clinical lung disease including: Asthma Allergy COPD Non-invasive ventilation Sleep related breathing disorders Interstitial lung diseases Lung cancer Clinical genetics Rhinitis Airway and lung infection Epidemiology Pediatrics CRJ provides a fast-track service for selected Phase II and Phase III trial studies. Keywords Clinical Respiratory Journal, respiratory, pulmonary, medicine, clinical, lung disease, Abstracting and Indexing Information Academic Search (EBSCO Publishing) Academic Search Alumni Edition (EBSCO Publishing) Embase (Elsevier) Health & Medical Collection (ProQuest) Health Research Premium Collection (ProQuest) HEED: Health Economic Evaluations Database (Wiley-Blackwell) Hospital Premium Collection (ProQuest) Journal Citation Reports/Science Edition (Clarivate Analytics) MEDLINE/PubMed (NLM) ProQuest Central (ProQuest) Science Citation Index Expanded (Clarivate Analytics) SCOPUS (Elsevier)