地塞米松预处理对晚期非小细胞肺癌一线免疫治疗疗效及免疫相关不良事件的影响:随机对照试验的网络荟萃分析

IF 1.4 Q4 IMMUNOLOGY American journal of clinical and experimental immunology Pub Date : 2021-12-15 eCollection Date: 2021-01-01
Yanwei Li, Feng He, Shuang Liu, Yu Zhang, Ling Li, Bin Wang, Lan Lan, Zhanyu Pan
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引用次数: 0

摘要

背景:地塞米松预处理对程序性细胞死亡1/程序性细胞死亡1配体1 (PD1/PDL1)抑制剂免疫治疗的疗效和免疫相关不良事件的影响是晚期非小细胞肺癌(NSCLC)一线治疗的有效选择。皮质类固醇具有免疫抑制作用,可用于降低PDL1阻断的疗效,并防止过度活跃的免疫反应,从而减少免疫相关不良事件(irAEs)的发生。本研究定量总结了现有的证据,比较了化疗+ PDL1抑制剂+地塞米松预处理(I+C+D)与化疗+ PDL1抑制剂(I+C)和化疗+ PDL1抑制剂或单独化疗(I或C)的疗效和毒性。方法:本研究方案在PROSPERO注册(CRD42021227281)。采用网络元分析方法,根据不同等级的疗效和irae率对不同治疗进行比较和排序。通过直接荟萃分析和间接治疗比较确定风险率。结果:纳入12项随机临床试验,共纳入7155例NSCLC患者。网络荟萃分析产生了15个比较。与单药治疗相比,I+C+D联合治疗的无进展生存期和总生存期更长,而I+C的毒性更小,且I+C+D或I+C的毒性明显降低。根据分级分析,I+C+D是最有效的治疗策略,而I+C与最低的irAEs发生率相关,分级值≥3。结论:I+C+D联合治疗是一线治疗I+C、I、C治疗NSCLC患者最有效的方法。
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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Effect of pretreatment with dexamethasone on the efficacy and immune-related adverse events of immunotherapy in first-line treatment for advanced non-small cell lung cancer: a network meta-analysis of randomized control trials.

Background: The pretreatment of dexamethasone on the efficacy and immune-related adverse events of immunotherapy involving programmed cell death 1/programmed cell death 1 ligand 1 (PD1/PDL1) inhibitors is an effective option for the first-line treatment of advanced non-small-cell lung cancer (NSCLC). With the immunosuppressive effect, corticosteroids may be used to reduce the efficacy of PDL1 blockade, as well as prevent overactive immune responses, thereby reducing the occurrence of immune-related adverse events (irAEs). This study quantitatively summarized the current evidence, and compared the efficacy and toxicity of therapies involving chemotherapy plus PDL1 inhibitors plus dexamethasone pretreatment (I+C+D) with chemotherapy plus PDL1 inhibitors (I+C) and therapies involving PDL1 inhibitors or chemotherapy alone (I or C).

Methods: The protocol of this study was registered with PROSPERO (CRD42021227281). By using a network meta-analysis approach, the different treatments were compared and ranked based on their effectiveness and rates of irAEs at the different grades. Risk rates were determined through direct meta-analysis and indirect treatment comparison.

Results: 12 randomized clinical trials were included with a total of 7155 NSCLC patients. Network meta-analysis generated 15 comparisons. The combination treatment of I+C+D showed a longer progression-free survival and overall survival, while I+C was less toxic, and the toxicity of I+C+D or that of I+C had been significantly decreased, compared to that of monotherapy with either drug. According to the ranking analysis, I+C+D is consistently proved to be the most effective therapeutic strategy, while I+C is linked to the lowest rate of irAEs, with the rate of grade value of ≥3 irAEs.

Conclusion: The combination treatment of I+C+D is the most effective approach for the first-line treatment of NSCLC patients treated with I+C, I, or C.

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