同步免疫检查点抑制剂联合放疗或放化疗治疗晚期非小细胞肺癌的疗效和安全性：系统评价和单臂荟萃分析。

Efficacy and safety of concurrent immune checkpoint inhibitors combined with radiotherapy or chemoradiotherapy for advanced non-small cell lung cancer: A systematic review and single-arm meta-analysis.

机构信息

Department of Oncology, The First People's Hospital of Neijiang, Neijiang, Sichuan, China.

Department of Oncology, The Second People's Hospital of Neijiang, Neijiang, Sichuan, China.

出版信息

PLoS One. 2024 Jun 12;19(6):e0304941. doi: 10.1371/journal.pone.0304941. eCollection 2024.

BACKGROUND

The recent usage of immunotherapy combined with chemoradiotherapy has improved survival in advanced non-small cell lung cancer (NSCLC) patients. However, determining the most effective therapy combination remains a topic of debate. Research suggests immune checkpoint inhibitors (ICIs) post-chemoradiotherapy enhance survival, but the impact of concurrent ICIs during chemoradiotherapy on rapid disease progression is unclear. This meta-analysis aims to assess the effectiveness and safety of concurrent ICIs with radiotherapy or chemoradiotherapy in advanced non-small cell lung cancer.

METHODS

We searched PubMed, Embase, the Cochrane Library, and Web of Science for relevant studies, extracting data on overall response rate (ORR), progression-free survival (PFS), overall survival (OS), and adverse events (AEs).

RESULTS

The analysis included ten studies with 490 participants. Stage III NSCLC ORR was 81.8%, while Stage IV ORR was 39.9%. One-year PFS and OS for Stage III were 68.2% and 82.6%, compared to 27.9% and 72.2% for Stage IV. Common adverse events included anemia (46.6%), nausea (47.6%), rash (36.4%), and radiation pneumonitis (36.3%).

CONCLUSIONS

Our meta-analysis shows concurrent ICIs with chemoradiotherapy are effective and safe in advanced NSCLC, particularly in stage III patients at risk of progression before starting ICIs after chemoradiotherapy. The findings support further phase III trials. The review protocol was registered on PROSPERO (CRD42023493685) and is detailed on the NIHR HTA programme website.

背景

免疫疗法联合放化疗在晚期非小细胞肺癌（NSCLC）患者中的应用，提高了患者的生存率。然而，哪种治疗联合方案最有效仍存在争议。有研究表明，放化疗后使用免疫检查点抑制剂（ICI）可提高生存率，但放化疗期间同时使用 ICI 对快速疾病进展的影响尚不清楚。本荟萃分析旨在评估晚期非小细胞肺癌中放疗或放化疗联合免疫检查点抑制剂的疗效和安全性。

方法

我们检索了 PubMed、Embase、Cochrane 图书馆和 Web of Science 中相关研究，提取了总缓解率（ORR）、无进展生存期（PFS）、总生存期（OS）和不良反应（AEs）的数据。

结果

分析纳入了 10 项研究，共 490 名参与者。III 期 NSCLC 的 ORR 为 81.8%，而 IV 期的 ORR 为 39.9%。III 期 NSCLC 的 1 年 PFS 和 OS 分别为 68.2%和 82.6%，而 IV 期 NSCLC 则分别为 27.9%和 72.2%。常见不良反应包括贫血（46.6%）、恶心（47.6%）、皮疹（36.4%）和放射性肺炎（36.3%）。

结论

我们的荟萃分析表明，晚期 NSCLC 患者放化疗期间联合使用 ICI 是有效且安全的，特别是在放化疗后开始使用 ICI 之前有进展风险的 III 期患者中。这些结果支持进一步开展 III 期临床试验。本研究方案已在 PROSPERO（CRD42023493685）注册，并在英国国家卫生与临床优化研究所（NIHR）卫生技术评估（HTA）项目网站上详细介绍。