免疫检查点抑制剂治疗失败后的非小细胞肺癌全身治疗方案:基于随机对照试验的贝叶斯网络荟萃分析。

IF 2.9 4区 医学 Q3 IMMUNOLOGY BMC Immunology Pub Date : 2024-06-28 DOI:10.1186/s12865-024-00633-z
Kang Wang, Zhenxue Fu, Guanxing Sun, Yancui Ran, Nannan Lv, Enbo Wang, Huan Ding
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引用次数: 0

摘要

背景:尽管免疫检查点抑制剂(ICIs)为非小细胞肺癌(NSCLC)带来了生存益处,但疾病进展仍时有发生,而且对于这些患者的治疗方案尚未达成共识。我们设计了一项网络荟萃分析(NMA)来评估 ICIs 治疗失败后 NSCLC 的系统治疗方案:方法:检索了 PubMed、Embase、Web of Science 和 Cochrane Library 数据库,然后进行文献筛选和 NMA。我们纳入了所有II期和III期随机对照试验(RCT)。无进展生存期(PFS)和总生存期(OS)采用危险比(HR)进行评估。客观反应率(ORR)和不良事件(AEs)分别采用了几率比(OR)和相对风险(RR)效应大小。应用 R 软件比较贝叶斯 NMA 结果:我们最终纳入了 6 项研究。1322名患者接受了ICI+化疗(ICI + Chemo)、ICI+抗血管生成单克隆抗体(ICI + Antiangio-Ab)、ICI+酪氨酸激酶抑制剂(ICI + TKI)、酪氨酸激酶抑制剂+化疗(TKI + Chemo)、标准护理(SOC)、化疗(Chemo)。TKI+化疗可获得更长的PFS和更高的ORR(累积排名曲线下表面值[SUCRA],99.7%和88.2%),ICI+TKI可获得最长的OS(SUCRA,82.7%)。在任何级别的不良事件(AEs)、大于或等于3级的不良事件以及导致停止治疗的任何级别的不良事件(SUCRA,95%,82%,93%)方面,ICI + Antiangio-Ab的安全性评分最高:对于使用 ICIs 治疗失败的 NSCLC 患者,TKI + 化疗可获得更长的 PFS 和更高的 ORR,而 ICI + TKI 可获得最长的 OS。就安全性而言,ICI + 抗原抗体的安全性最高。
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Systemic treatment options for non-small cell lung cancer after failure of previous immune checkpoint inhibitors: a bayesian network meta-analysis based on randomized controlled trials.

Background: Although immune checkpoint inhibitors (ICIs) have brought survival benefits to non-small cell lung cancer (NSCLC), disease progression still occurs, and there is no consensus on the treatment options for these patients. We designed a network meta-analysis (NMA) to evaluate systemic treatment options for NSCLC after failure of ICIs.

Methods: PubMed, Embase, Web of Science and Cochrane Library databases were searched, then literature screening was followed by NMA. We included all Phase II and III randomized controlled trials (RCTs). Progression-free survival (PFS) and overall survival (OS) used hazard ratio (HR) for evaluation. Objective response rate (ORR) and adverse events (AEs) used odds ratio (OR) and relative risk (RR) effect sizes, respectively. R software was applied to compare the Bayesian NMA results.

Results: We finally included 6 studies. 1322 patients received ICI plus Chemotherapy (ICI + Chemo), ICI plus Anti-angiogenic monoclonal antibody (ICI + Antiangio-Ab), ICI plus Tyrosine kinase inhibitor (ICI + TKI), Tyrosine kinase inhibitor plus Chemotherapy (TKI + Chemo), Standard of Care (SOC), Chemotherapy (Chemo). TKI + Chemo is associated with longer PFS, higher ORR (surface under cumulative ranking curve [SUCRA], 99.7%, 88.2%), ICI + TKI achieved the longest OS (SUCRA, 82.7%). ICI + Antiangio-Ab was granted the highest safety rating for adverse events (AEs) of any grade, AEs greater than or equal to grade 3 and AEs of any grade leading to discontinuation of treatment (SUCRA, 95%, 82%, 93%).

Conclusions: For NSCLC after failure of ICIs, TKI + Chemo was associated with longer PFS and higher ORR, while ICI + TKI was associated with the longest OS. In terms of safety, ICI + Antiangio-Ab was the highest.

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来源期刊
BMC Immunology
BMC Immunology 医学-免疫学
CiteScore
5.50
自引率
0.00%
发文量
54
审稿时长
1 months
期刊介绍: BMC Immunology is an open access journal publishing original peer-reviewed research articles in molecular, cellular, tissue-level, organismal, functional, and developmental aspects of the immune system as well as clinical studies and animal models of human diseases.
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