ipilimumab和nivolumab联合应用治疗脑转移黑色素瘤患者的疗效和安全性:一项系统回顾和荟萃分析

IF 2.9 4区 医学 Q3 IMMUNOLOGY
Mengmeng Su, Yuyan Yang, Peng Wang
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引用次数: 1

摘要

背景:免疫检查点抑制剂是黑色素瘤患者的高级免疫疗法。目的:本研究评价伊匹单抗联合纳武单抗(IN)治疗黑色素瘤脑转移(MBM)患者的疗效和安全性。材料和方法:在电子数据库中进行文献检索,凡报道in对MBM患者的疗效和安全性或与脑转移相关的预后信息的研究均被纳入。评估的结果包括客观缓解率(ORR)、完全缓解/疾病稳定/疾病进展率、无进展生存期(PFS)、总生存期(OS)、不良事件发生率以及有和无脑转移的in治疗患者之间疾病进展或死亡率的风险比。结果:in治疗的MBM患者颅内ORR高于对照治疗(纳武单抗或伊匹单抗加福莫司汀)。IN治疗比对照治疗的PFS和OS更长。in治疗的MBM患者的5年OS高达51%,而纳武单抗治疗的5年OS为34%。治疗naïve和无症状患者的结果更好。尽管许多研究报道,与非MBM黑色素瘤患者相比,MBM患者接受IN治疗的死亡率或进展风险明显更高,但许多其他研究并未发现这种风险显著。in治疗的MBM患者3/4级不良事件的发生率为:腹泻或结肠炎(16%)、肝炎(15%)、皮疹(8%)、谷丙转氨酶升高(8%)、天冬氨酸转氨酶升高(7%)、脂肪酶升高(6%)、淀粉酶升高(4%)、疲劳(3%)、垂体炎(2%)、肺炎(2%)、头痛(2%)、恶心或呕吐(1%)和中性粒细胞减少症(1%)。结论:IN是一种有效且安全的治疗MBM患者的选择,特别是对于无症状和正在治疗naïve患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Efficacy and safety of the combined use of ipilimumab and nivolumab for melanoma patients with brain metastases: a systematic review and meta-analysis.

Context: Immune checkpoint inhibitors have advanced immunotherapy for melanoma patients.Objective: This study evaluates efficacy and safety of ipilimumab and nivolumab combination (IN) for melanoma brain metastases (MBM) patients.

Materials and methods: Literature search was conducted in electronic databases and studies were included if they reported efficacy and safety of IN in MBM patients or prognostic information related to brain metastases. Outcomes evaluated were objective response rate (ORR), complete remission/stable disease/progressive disease rates, progression-free survival (PFS), overall survival (OS), incidence rates of adverse events, and hazard ratios of disease progression or mortality between IN-treated patients with and without brain metastasis.

Results: Intracranial ORR was higher in IN-treated MBM patients than with control therapies (nivolumab or ipilimumab plus fotemustine). IN treatment led to longer PFS and OS in than control treatments. Five-year OS of IN-treated MBM patients was up to 51% compared to 34% for nivolumab. Outcomes were better for treatment naïve and asymptomatic patients. Whereas many studies reported significantly higher mortality or progression risk with IN treatment in MBM patients compared to non-MBM melanoma patients, many others did not find this risk significant. Incidence of grade 3/4 adverse events in IN-treated MBM patients was: diarrhea or colitis (16%), hepatitis (15%), rash (8%), increased alanine transaminase (8%), increased aspartate aminotransferase (7%), increased lipase (6%), increased amylase (4%), fatigue (3%), hypophysitis (2%), pneumonitis (2%), headache (2%), nausea or vomiting (1%), and neutropenia (1%).

Conclusion: IN is an efficacious and safer treatment option for MBM patients, especially for asymptomatic and treatment naïve patients.

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来源期刊
CiteScore
5.40
自引率
0.00%
发文量
133
审稿时长
4-8 weeks
期刊介绍: The journal Immunopharmacology and Immunotoxicology is devoted to pre-clinical and clinical drug discovery and development targeting the immune system. Research related to the immunoregulatory effects of various compounds, including small-molecule drugs and biologics, on immunocompetent cells and immune responses, as well as the immunotoxicity exerted by xenobiotics and drugs. Only research that describe the mechanisms of specific compounds (not extracts) is of interest to the journal. The journal will prioritise preclinical and clinical studies on immunotherapy of disorders such as chronic inflammation, allergy, autoimmunity, cancer etc. The effects of small-drugs, vaccines and biologics against central immunological targets as well as cell-based therapy, including dendritic cell therapy, T cell adoptive transfer and stem cell therapy, are topics of particular interest. Publications pointing towards potential new drug targets within the immune system or novel technology for immunopharmacological drug development are also welcome. With an immunoscience focus on drug development, immunotherapy and toxicology, the journal will cover areas such as infection, allergy, inflammation, tumor immunology, degenerative disorders, immunodeficiencies, neurology, atherosclerosis and more. Immunopharmacology and Immunotoxicology will accept original manuscripts, brief communications, commentaries, mini-reviews, reviews, clinical trials and clinical cases, on the condition that the results reported are based on original, clinical, or basic research that has not been published elsewhere in any journal in any language (except in abstract form relating to paper communicated to scientific meetings and symposiums).
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