Efficacy and safety of immunotherapy combined with chemotherapy in patients with ES-SCLC: A systematic review and network meta-analysis of RCTs and RWSs.

IF 2.3 3区医学 Q3 ONCOLOGY Thoracic Cancer Pub Date : 2024-11-01 Epub Date: 2024-10-13 DOI:10.1111/1759-7714.15458

Runting Kang, Junling Ma, Bin Ai, Juanjuan Liu, Zitong Zheng, Jiangyong Yu

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Abstract

Objectives: To evaluate the efficacy and safety of programmed cell death 1 (PD-1)/programmed cell death ligand 1 (PD-L1) inhibitors in the treatment of extensive-stage small-cell lung cancer (ES-SCLC), we conducted a systematic review and meta-analysis that included randomized controlled trials (RCTs) and real-world studies (RWS).

Methods: By scanning PubMed, Web of science, Embase, and other relevant clinical information public databases, nine RCTs and eight RWSs involving 5205 patients were included in the study. We directly compared the differences between chemotherapy and PD-1/PD-L1 inhibitors plus chemotherapy, and determined the optimal treatment strategy through network meta-analysis (NMA).

Results: Compared to chemotherapy, the addition of PD-1/PD-L1 inhibitors significantly improves the overall survival (OS), progression-free survival (PFS), and objective response rate (ORR) in SCLC patients. Regarding safety, both RCTs and RWSs indicated no significant difference in grade 3-4 adverse events between chemotherapy and chemoimmunotherapy. NMA showed serplulimab plus chemotherapy (Serp_Chemo) appears to provide the best OS, PFS, and ORR benefit, while nivolumab plus chemotherapy shows higher toxicity than other regimens. In subgroup analysis, for elderly patients (age ≥65) and non-elderly (age <65) patients, the most promising quality regimens for achieving better OS extension are atezolizumab plus chemotherapy (Atez_Chemo) and Serp_Chemo, respectively. For patients with PD-L1 ≥ 1% and lactate dehydrogenase (LDH) > upper limit of normal (ULN), there is no apparent OS benefit from immune therapy.

Conclusions: In ES-SCLC treatment, adding PD-1/PD-L1 inhibitors to standard chemotherapy improves OS, PFS, and ORR, with Serp_Chemo shows the most promise. Atez_Chemo and Serp_Chemo provided better survival for elderly and non-elderly patients, respectively.

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免疫疗法联合化疗对 ES-SCLC 患者的疗效和安全性：对RCT和RWS进行系统回顾和网络荟萃分析。

研究目的为了评估程序性细胞死亡1（PD-1）/程序性细胞死亡配体1（PD-L1）抑制剂治疗广泛期小细胞肺癌（ES-SCLC）的疗效和安全性，我们进行了一项系统综述和荟萃分析，其中包括随机对照试验（RCT）和真实世界研究（RWS）：通过扫描PubMed、Web of science、Embase和其他相关临床信息公共数据库，研究纳入了9项RCT和8项RWS，涉及5205名患者。我们直接比较了化疗与PD-1/PD-L1抑制剂联合化疗之间的差异，并通过网络荟萃分析（NMA）确定了最佳治疗策略：与化疗相比，加用PD-1/PD-L1抑制剂能显著提高SCLC患者的总生存期（OS）、无进展生存期（PFS）和客观反应率（ORR）。在安全性方面，RCT 和 RWS 均显示化疗和化学免疫疗法在 3-4 级不良事件方面无明显差异。NMA显示，serplulimab联合化疗（Serp_Chemo）似乎能提供最佳的OS、PFS和ORR获益，而nivolumab联合化疗的毒性高于其他方案。在亚组分析中，对于老年患者（年龄≥65岁）和非老年患者（年龄正常值上限（ULN）），免疫疗法没有明显的OS获益：结论：在ES-SCLC治疗中，在标准化疗中加入PD-1/PD-L1抑制剂可改善OS、PFS和ORR，其中Serp_Chemo最有前景。Atez_Chemo和Serp_Chemo分别为老年和非老年患者提供了更好的生存率。

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来源期刊

Thoracic Cancer ONCOLOGY-RESPIRATORY SYSTEM

CiteScore

5.20

自引率

3.40%

发文量

439

审稿时长

2 months

期刊介绍： Thoracic Cancer aims to facilitate international collaboration and exchange of comprehensive and cutting-edge information on basic, translational, and applied clinical research in lung cancer, esophageal cancer, mediastinal cancer, breast cancer and other thoracic malignancies. Prevention, treatment and research relevant to Asia-Pacific is a focus area, but submissions from all regions are welcomed. The editors encourage contributions relevant to prevention, general thoracic surgery, medical oncology, radiology, radiation medicine, pathology, basic cancer research, as well as epidemiological and translational studies in thoracic cancer. Thoracic Cancer is the official publication of the Chinese Society of Lung Cancer, International Chinese Society of Thoracic Surgery and is endorsed by the Korean Association for the Study of Lung Cancer and the Hong Kong Cancer Therapy Society. The Journal publishes a range of article types including: Editorials, Invited Reviews, Mini Reviews, Original Articles, Clinical Guidelines, Technological Notes, Imaging in thoracic cancer, Meeting Reports, Case Reports, Letters to the Editor, Commentaries, and Brief Reports.