Zhu Youwen, Liu Kun, Zhu Hong, Cao Hui, Zhou Yangying
Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Department of Oncology, Chenzhou First People's Hospital, Chenzhou, Hunan 423000, China.
Ther Adv Med Oncol. 2023 Oct 14;15:17588359231206147. doi: 10.1177/17588359231206147. eCollection 2023.
Recently, several new first-line immune checkpoint inhibitors (ICIs) plus chemotherapy have been approved for patients with extensive-stage small-cell lung cancer (ES-SCLC). However, direct comparisons between first-line treatments are lacking. Therefore, we indirectly compared the efficacy and safety of specific treatment strategies to inform physicians' and patients' clinical decisions.
The Pubmed, Cochrane, Embase, and Web of Science databases were searched from 1 January 2000 to 27 November 2022, for randomized clinical trials (RCTs) assessing first-line immuno-chemotherapies for ES-SCLC. A fixed-effect multivariable meta-regression model was established for frequentist network meta-analysis and hazard ratios (HRs) with 95% confidence intervals (95% CI) were computed to compare the effects of immuno-chemotherapies on patient overall survival (OS) and progression-free survival (PFS), while risk ratios with 95% CI were used for treatment- and immune-related adverse events (AEs). The score values were then used to rank treatments based on their odds of being the best treatment option. The research protocol was registered with the PROSPERO (CRD42022383254).
Seven studies involving 3822 patients were eligible for analysis. Serplulimab plus chemotherapy had better OS outcomes compared to chemotherapy (HR = 0.63; 95% CI: 0.49-0.82) and ipilimumab plus chemotherapy (HR = 0.67; 95% CI: 0.50-0.90). It additionally exhibited better PFS outcomes compared to chemotherapy (HR = 0.48; 95% CI: 0.39-0.60), adebrelimab (HR = 0.72; 95% CI: 0.53-0.97), atezolizumab (HR = 0.62; 0.46-0.85), durvalumab (HR = 0.60; 95% CI: 0.45-0.80), durvalumab and tremelimumab (HR = 0.57; 95% CI: 0.43-0.76), ipilimumab (HR = 0.57; 95% CI: 0.44-0.73), and pembrolizumab (HR = 0.64; 95% CI: 0.48-0.86) plus chemotherapy. Serplulimab plus chemotherapy was linked to the greatest odds of effectively reducing the odds of death ( score = 0.87) and progression ( score = 0.99) while exhibiting a good safety profile.
Serplulimab plus chemotherapy exhibited the best survival outcomes with manageable AEs. Thus, serplulimab plus chemotherapy may represent the optimal best first-line treatment option for ES-SCLC patients.
最近，几种新型一线免疫检查点抑制剂（ICI）联合化疗已被批准用于广泛期小细胞肺癌（ES-SCLC）患者。然而，一线治疗之间缺乏直接比较。因此，我们间接比较了特定治疗策略的疗效和安全性，以为医生和患者的临床决策提供参考。
检索了2000年1月1日至2022年11月27日的Pubmed、Cochrane、Embase和Web of Science数据库，以查找评估ES-SCLC一线免疫化疗的随机临床试验（RCT）。建立了固定效应多变量meta回归模型用于频率学派网络meta分析，并计算了95%置信区间（95%CI）的风险比（HR），以比较免疫化疗对患者总生存期（OS）和无进展生存期（PFS）的影响，而95%CI的风险比用于治疗相关和免疫相关不良事件（AE）。然后使用 评分值根据其成为最佳治疗选择的可能性对治疗进行排名。该研究方案已在PROSPERO（CRD42022383254）注册。
七项涉及3822例患者的研究符合分析条件。与化疗（HR = 0.63；95%CI：0.49 - 0.82）和伊匹木单抗联合化疗（HR = 0.67；95%CI：0.50 - 0.90）相比，斯鲁利单抗联合化疗具有更好的OS结局。与化疗（HR = 0.48；95%CI：0.39 - 0.60）、阿得贝利单抗（HR = 0.72；95%CI：0.53 - 0.97）、阿替利珠单抗（HR = 0.62；0.46 - 0.85）、度伐利尤单抗（HR = 0.60；95%CI：0.45 - 0.80）、度伐利尤单抗和曲美木单抗（HR = 0.57；95%CI：0.43 - 0.76）、伊匹木单抗（HR = 0.57；95%CI：0.44 - 0.73）以及帕博利珠单抗（HR = 0.64；95%CI：0.48 - 0.86）联合化疗相比，它还表现出更好的PFS结局。斯鲁利单抗联合化疗与有效降低死亡几率（评分 = 0.87）和进展几率（评分 = 0.99）的最大可能性相关，同时显示出良好的安全性。
斯鲁利单抗联合化疗表现出最佳的生存结局，且不良事件可控。因此，斯鲁利单抗联合化疗可能是ES-SCLC患者最佳的一线治疗选择。
