Guo Xiaotong, Lin Lede, Zhu Jiang
Department of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu 610041, China.
Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu 610041, China.
J Clin Med. 2023 Mar 27;12(7):2531. doi: 10.3390/jcm12072531.
(1) Background: Malignant pleural mesothelioma (MPM) is a rare but aggressive tumor arising from the pleural surface. For relapsed MPM, there is no accepted standard of- are for subsequent treatment. Thus, we aimed to compare the efficacy of chemotherapy, targeting drugs, and immune-checkpoint inhibitors (ICIs) as subsequent therapy for relapsed MPM. (2) Methods: The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched several acknowledged databases. Primary outcomes were defined as overall median progressive survival (mPFS) and median overall survival (mOS) in different treatment groups. Secondary outcomes were defined as objective response rate (ORR), the proportion of stable disease (SD), and progressive disease (PD). (3) Results: Ultimately, 43 articles were selected for the meta-analysis. According to the results of a pooled analysis of single-arm studies, ICIs showed a slight advantage in mOS, while chemotherapy showed a slight advantage in mPFS (mOS: 11.2 m vs. 10.39 m and mPFS: 4.42 m vs. 5.08 m for ICIs group and chemotherapy group, respectively). We identified only a few studies that directly compared the efficacy of ICIs with that of chemotherapy, and ICIs did not show significant benefits over chemotherapy based on mOS. (4) Conclusions: Based on current evidence, we considered that immunotherapy might not be superior to chemotherapy as a subsequent therapy for relapsed MPM. Although several studies investigated the efficacy of ICIs, targeting drugs, and chemotherapy in relapsed MPM, there was still no standard of care. Further randomized control trials with consistent criteria and outcomes are recommended to guide subsequent therapy in relapsed MPM and identify patients with certain characteristics that might benefit from such subsequent therapy.
(1) 背景：恶性胸膜间皮瘤（MPM）是一种起源于胸膜表面的罕见但侵袭性强的肿瘤。对于复发的MPM，后续治疗尚无公认的标准。因此，我们旨在比较化疗、靶向药物和免疫检查点抑制剂（ICI）作为复发MPM后续治疗的疗效。(2) 方法：本研究按照系统评价和Meta分析的首选报告项目（PRISMA）进行。我们检索了几个公认的数据库。主要结局定义为不同治疗组的总体中位无进展生存期（mPFS）和中位总生存期（mOS）。次要结局定义为客观缓解率（ORR）、疾病稳定（SD）比例和疾病进展（PD）比例。(3) 结果：最终，43篇文章被选入Meta分析。根据单臂研究的汇总分析结果，ICI在mOS方面显示出轻微优势，而化疗在mPFS方面显示出轻微优势（ICI组和化疗组的mOS分别为11.2个月对10.39个月，mPFS分别为4.42个月对5.08个月）。我们仅发现少数直接比较ICI与化疗疗效的研究，基于mOS，ICI并未显示出优于化疗的显著益处。(4) 结论：基于目前的证据，我们认为免疫疗法作为复发MPM的后续治疗可能并不优于化疗。尽管有几项研究调查了ICI、靶向药物和化疗在复发MPM中的疗效，但仍没有标准的治疗方案。建议进行更多具有一致标准和结局的随机对照试验，以指导复发MPM的后续治疗，并识别可能从此类后续治疗中获益的具有特定特征的患者。
