先天和适应性免疫疗法联合标准治疗方案治疗高级别脑胶质瘤的疗效和安全性：系统评价和荟萃分析。
Efficacy and safety of innate and adaptive immunotherapy combined with standard of care in high-grade gliomas: a systematic review and meta-analysis.
机构信息
Department of Plastic Surgery, China-Japan Union Hospital of Jilin University, Changchun, China.
Department of Pathophysiology, College of Basic Medical Sciences of Jilin University, Changchun, Jilin, China.
出版信息
Front Immunol. 2023 Jul 6;14:966696. doi: 10.3389/fimmu.2023.966696. eCollection 2023.
BACKGROUND
Malignant glioma is the most common intracranial malignant tumor with the highest mortality. In the era of immunotherapy, it is important to determine what type of immunotherapy provides the best chance of survival.
METHOD
Here, the efficacy and safety of immunotherapy in high-grade glioma (HGG) were evaluated by systematic review and meta-analysis. The differences between various types of immunotherapy were explored. Retrieved hits were screened for inclusion in 2,317 articles. We extracted the overall survival (OS) and progression-free survival (PFS) hazard ratios (HRs) as two key outcomes for examining the efficacy of immunotherapy. We also analyzed data on the reported corresponding adverse events to assess the safety of immunotherapy. This study was registered with PROSPERO (CRD42019112356).
RESULTS
We included a total of 1,271 patients, of which 524 received a combination of immunotherapy and standard of care (SOC), while 747 received SOC alone. We found that immunotherapy extended the OS (HR = 0.74; 95% confidence interval [CI], 0.56-0.99; = -2.00, = 0.0458 < 0.05) and PFS (HR = 0.67; 95% CI, 0.45-0.99; = -1.99, = 0.0466 < 0.05), although certain adverse events occurred (proportion = 0.0773, 95% CI, 0.0589-0.1014). Our data have demonstrated the efficacy of the dendritic cell (DC) vaccine in prolonging the OS (HR = 0.38; 95% CI, 0.21-0.68; Z = -3.23; = 0.0012 < 0.05) of glioma patients. Oncolytic viral therapy (VT) only extended patient survival in a subgroup analysis (HR = 0.60; 95% CI, 0.45-0.80; = -3.53; = 0.0004 < 0.05). By contrast, immunopotentiation (IP) did not prolong OS (HR = 0.69; 95% CI, 0.50-0.96; = -2.23; = 0.0256).
CONCLUSION
Thus, DC vaccination significantly prolonged the OS of HGG patients, however, the efficacy of VT and IP should be explored in further studies. All the therapeutic schemes evaluated were associated with certain side effects.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=112356.
背景
恶性胶质瘤是最常见的颅内恶性肿瘤，死亡率最高。在免疫治疗时代，确定哪种类型的免疫治疗提供最好的生存机会非常重要。
方法
本研究通过系统评价和荟萃分析评估了免疫疗法在高级别胶质瘤（HGG）中的疗效和安全性。探讨了不同类型免疫疗法之间的差异。从 2317 篇文章中筛选出符合纳入标准的研究。我们提取了总生存期（OS）和无进展生存期（PFS）的风险比（HR）作为评估免疫治疗疗效的两个关键指标。我们还分析了报告的相应不良事件数据，以评估免疫治疗的安全性。本研究已在 PROSPERO（CRD42019112356）上注册。
结果
我们共纳入了 1271 名患者，其中 524 名患者接受了免疫治疗联合标准治疗（SOC），747 名患者仅接受 SOC。我们发现免疫治疗延长了 OS（HR=0.74；95%置信区间[CI]，0.56-0.99； =-2.00， =0.0458<0.05）和 PFS（HR=0.67；95%CI，0.45-0.99； =-1.99， =0.0466<0.05），但某些不良反应也发生了（比例=0.0773，95%CI，0.0589-0.1014）。我们的数据表明树突状细胞（DC）疫苗在延长胶质瘤患者 OS 方面具有疗效（HR=0.38；95%CI，0.21-0.68；Z=-3.23； =0.0012<0.05）。溶瘤病毒治疗（VT）仅在亚组分析中延长了患者的生存时间（HR=0.60；95%CI，0.45-0.80； =-3.53； =0.0004<0.05）。相比之下，免疫增强（IP）并未延长 OS（HR=0.69；95%CI，0.50-0.96； =-2.23； =0.0256）。
结论
因此，DC 疫苗接种显著延长了 HGG 患者的 OS，但 VT 和 IP 的疗效需要进一步研究。所有评估的治疗方案都有一定的副作用。
系统评价注册
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=112356。
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