评价不同新辅助免疫治疗联合方案在局部晚期头颈部鳞癌中的疗效和安全性：一项系统评价和荟萃分析。
Evaluating the efficacy and safety of different neoadjuvant immunotherapy combinations in locally advanced HNSCC: a systematic review and meta-analysis.
机构信息
Department of Burns and Plastic Surgery, Yantaishan Hospital, Yantai, China.
Department of implantology, Affiliated Hospital of Binzhou Medical College, Yantai Stomatology Hospital, Yantai, China.
出版信息
Front Immunol. 2024 Aug 29;15:1467306. doi: 10.3389/fimmu.2024.1467306. eCollection 2024.
BACKGROUND
Immune checkpoint inhibitors have demonstrated promising therapeutic outcomes in recurrent/metastatic (R/M) Head and Neck Squamous Cell Carcinoma (HNSCC), prompting numerous clinical trials to investigate the safety and efficacy of this approach in neoadjuvant therapy. This systematic review aims to consolidate and analyze the findings from various clinical trials combining neoadjuvant immunotherapy for HNSCC, with the goal of identifying the most effective neoadjuvant immunotherapy regimen.
METHODS
The system conducted searches across electronic databases including PubMed, Embase, the Cochrane Library and Web of science from their inception to July 1, 2024. The primary focus was on evaluating efficacy (particularly pathological complete response (pCR), major pathological response (MPR), and overall response rate (ORR)) and safety (primarily assessed by grade 3-4 treatment-related adverse reactions).
RESULTS
A total of 1943 patients from 32 studies were analyzed. Combining neoadjuvant immunotherapy with chemotherapy or radiotherapy demonstrated superiority over neoadjuvant immunotherapy alone in terms of the MPR rate, while showing no statistically significant difference in the pCR rate. Furthermore, the combination of neoadjuvant immunotherapy with chemotherapy or radiotherapy exhibited a lower CR rate compared to neoadjuvant immunotherapy with radiotherapy alone, but a higher PR rate and SD rate. Apart from the neoadjuvant immunotherapy group in isolation, there were no statistically significant differences in grade ≥3 treatment-related adverse events (TRAEs) and immune-related adverse events (irAEs) among the other three combination therapy groups.
CONCLUSION
This systematic review and meta-analysis indicate that patients with locally advanced HNSCC might benefit from neoadjuvant immunotherapy, particularly when used in conjunction with chemotherapy or radiotherapy. Nonetheless, additional data is required to definitively confirm its efficacy.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=553753, identifier CRD42024553753.
背景
免疫检查点抑制剂在复发性/转移性（R/M）头颈部鳞状细胞癌（HNSCC）中显示出有前途的治疗效果，促使许多临床试验研究新辅助治疗中这种方法的安全性和疗效。本系统评价旨在综合和分析联合新辅助免疫治疗 HNSCC 的各种临床试验结果，以确定最有效的新辅助免疫治疗方案。
方法
系统检索了从建库到 2024 年 7 月 1 日的电子数据库，包括 PubMed、Embase、Cochrane 图书馆和 Web of science。主要重点是评估疗效（特别是病理完全缓解（pCR）、主要病理缓解（MPR）和总缓解率（ORR））和安全性（主要通过 3-4 级治疗相关不良反应评估）。
结果
共分析了来自 32 项研究的 1943 名患者。与新辅助免疫治疗单药相比，新辅助免疫联合化疗或放疗在 MPR 率方面表现出优越性，而在 pCR 率方面没有统计学差异。此外，与单纯新辅助免疫联合放疗相比，新辅助免疫联合化疗或放疗的 CR 率较低，但 PR 率和 SD 率较高。除了新辅助免疫治疗组外，其他三组联合治疗组之间的 3 级及以上治疗相关不良事件（TRAEs）和免疫相关不良事件（irAEs）无统计学差异。
结论
本系统评价和荟萃分析表明，局部晚期 HNSCC 患者可能受益于新辅助免疫治疗，特别是与化疗或放疗联合使用时。然而，还需要更多的数据来明确其疗效。
系统评价注册
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=553753，标识符 CRD42024553753。
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