Evidence-Based Medicine Center, MOE Virtual Research Center of Evidence-based Medicine at Zunyi Medical College, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou, China; Department of General Practice, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou, China.
Department of Infectious Diseases, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou, China.
Int Immunopharmacol. 2022 Jun;107:108688. doi: 10.1016/j.intimp.2022.108688. Epub 2022 Mar 12.
Thymic peptides (TPs) are often used to control malignant pleural effusion (MPE). So, we performed a clustered systematic review and meta-analysis to clarify the treatment regimens of TPs for MPE, demonstrate their clinical effectiveness and safety, and reveal the indications and optimal usage for a desired effectiveness.
We collected all trials of TPs for MPE from Chinese and English databases (from inception until May 2021). After evaluating their bias risk, we pooled the data from each regimen using the meta-analysis or descriptive analysis, and summarized the evidence quality using the Grading of Recommendation Assessment, Development and Evaluation approach (GRADE).
Thirty-four trials were clustered into TPs for MPE from lung cancer or miscellaneous tumors. The TPs combined with chemical agents were mainly used in MPE from lung cancer. All five regimens, only thymosin with oxaliplatin (L-OHP) significantly improved the complete response (CR) [2.40 (1.84 to 3.13)], quality of life [2.04 (1.20 to 3.48)], 0.5- and 1-year overall survival (OS) rate [5.75 (3.02 to 10.92) and 5.29, (1.71 to 16.36)]. It also up-regulated the T lymphocyte levels, and reduced the pleurodesis failure, disease progression and adverse events. In patients with moderate to large volume, Karnofsky Performance Status score ≥ 50 or anticipated survival time ≥ 3 months, the thymosin (300 mg/time, one time/week and lasting two to eight times) with oxaliplatin (100 mg/m) achieved a desired response. Most results were moderate quality.
The current evidences indicate that the TPs are important pleurodesis agents, which combination with chemical agents are mainly used in MPE from lung cancer. The thymosin with L-OHP is a main regimen, which shows a significant improvement in clinical responses, antitumor immunity, and with a reasonable security. The evidence also provides indications and optimal usage for achieving a desired effectiveness.
胸腺肽（TPs）常用于控制恶性胸腔积液（MPE）。因此，我们进行了一项聚类系统评价和荟萃分析，以阐明 TPs 治疗 MPE 的方案，证明其临床疗效和安全性，并揭示获得理想疗效的适应证和最佳使用方法。
我们从中文和英文数据库中收集了所有关于 TPs 治疗 MPE 的试验（从开始到 2021 年 5 月）。在评估其偏倚风险后，我们使用荟萃分析或描述性分析对每个方案的数据进行了汇总，并使用推荐评估、制定与评估分级法（GRADE）对证据质量进行了总结。
34 项试验被聚类为来自肺癌或其他肿瘤的 MPE 的 TPs。TPs 联合化疗药物主要用于肺癌引起的 MPE。所有 5 种方案中，只有胸腺肽联合奥沙利铂（L-OHP）显著提高了完全缓解率（CR）[2.40（1.84 至 3.13）]、生活质量[2.04（1.20 至 3.48）]、0.5 年和 1 年总生存率（OS）率[5.75（3.02 至 10.92）和 5.29（1.71 至 16.36）]。它还上调了 T 淋巴细胞水平，降低了胸腔粘连失败、疾病进展和不良反应的发生率。在中等至大量胸腔积液、卡氏功能状态评分≥50 或预计生存时间≥3 个月的患者中，胸腺肽（300mg/次，每周 1 次，持续 2 至 8 次）联合奥沙利铂（100mg/m）可获得理想的反应。大多数结果为中等质量。
目前的证据表明，TPs 是重要的胸膜固定剂，与化疗药物联合主要用于肺癌引起的 MPE。胸腺肽联合 L-OHP 是一种主要方案，在临床反应、抗肿瘤免疫方面均有显著改善，且安全性合理。该证据还为获得理想疗效提供了适应证和最佳使用方法。
