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免疫检查点抑制剂与抗血管生成治疗在晚期非小细胞肺癌中的疗效和安全性的间接比较。

Indirect comparison of efficacy and safety between immune checkpoint inhibitors and antiangiogenic therapy in advanced non-small-cell lung cancer.

机构信息

Graduate Institute of Data Science, College of Management, Taipei Medical University, Taipei, Taiwan, Republic of China.

Research Center of Biostatistics, Taipei Medical University, Taipei, Taiwan, Republic of China.

出版信息

Sci Rep. 2018 Jun 26;8(1):9686. doi: 10.1038/s41598-018-27994-x.

Abstract

In this study, we conducted an indirect comparison analysis to compare the efficacy and safety of immune checkpoint inhibitors with those of antiangiogenic therapy-two effective treatment methods for advanced non-small-cell lung cancer (NSCLC). Eligible randomised control trials of immune checkpoint inhibitors, antiangiogenic therapy, and doublet platinum-based therapy published up to July 2017 were comprehensively analysed. Through the indirect comparison analysis of 37 trials involving 16810 patients, treatments were compared for overall survival (OS) and grade 3-5 adverse events. For first-line treatment, the use of pembrolizumab alone (hazard ratio [HR]: 0.6; 95% confidence interval [CI]: 0.4-0.91) and a combination of bevacizumab and doublet platinum-based therapy (HR: 0.86; 95% CI: 0.75-0.99) demonstrated substantial survival benefits compared with doublet platinum-based therapy. For subsequent treatment, nivolumab may provide higher efficacy and lower toxicity than antiangiogenic therapy. Overall, anti-PD1 monoclonal antibodies may be superior to antiangiogenic therapy in terms of OS and grade 3-5 adverse events. This meta-analysis suggests that pembrolizumab and nivolumab might be favourable choices for first-line and subsequent treatment, respectively, for patients with advanced NSCLC. Additional randomised control trials are required for a comprehensive evaluation of the outcomes among regimens.

摘要

在这项研究中,我们进行了间接比较分析,以比较免疫检查点抑制剂与抗血管生成治疗这两种有效治疗晚期非小细胞肺癌(NSCLC)的方法的疗效和安全性。综合分析了截至 2017 年 7 月发表的免疫检查点抑制剂、抗血管生成治疗和双联铂类药物治疗的合格随机对照试验。通过对 37 项涉及 16810 名患者的试验的间接比较分析,对总生存期(OS)和 3-5 级不良事件进行了比较。对于一线治疗,与双联铂类药物治疗相比,单独使用 pembrolizumab(风险比[HR]:0.6;95%置信区间[CI]:0.4-0.91)和贝伐珠单抗联合双联铂类药物治疗(HR:0.86;95%CI:0.75-0.99)具有显著的生存获益。对于后续治疗,nivolumab 可能比抗血管生成治疗具有更高的疗效和更低的毒性。总体而言,抗 PD1 单克隆抗体在 OS 和 3-5 级不良事件方面可能优于抗血管生成治疗。这项荟萃分析表明,pembrolizumab 和 nivolumab 分别可能是晚期 NSCLC 患者一线和后续治疗的有利选择。需要更多的随机对照试验来全面评估方案之间的结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/96ae/6018789/9c45f1a7e852/41598_2018_27994_Fig1_HTML.jpg

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