Song Chao, Qiu Yuan, Fan Huan, Han Yongqing
Department of Thoracic Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
Department of Oncology, Shangrao People's Hospital, Shangrao, China.
Front Oncol. 2025 May 21;15:1496611. doi: 10.3389/fonc.2025.1496611. eCollection 2025.
Combining PD-1/PD-L1 inhibitors with chemotherapy (PIC) is a standard first-line treatment for advanced non-small cell lung cancer (NSCLC). The addition of bevacizumab to this regimen (PD-1/PD-L1 inhibitors+bevacizumab+chemotherapy [PIBC]) remains controversial regarding its potential to enhance antitumor efficacy in clinical practice. This meta-analysis aims to compare the antitumor effectiveness and safety profiles of PIBC with PIC.
We systematically searched six databases to identify eligible RCTs. The primary outcomes were overall survival (OS) and progression-free survival (PFS), while the secondary outcomes included treatment responses and adverse events (AEs).
Three RCTs (IMpower150, jRCT2080224500, and ORIENT-31) comprising a total of 1529 patients were analyzed. The PIBC regimen significantly improved PFS (hazard ratio [HR]: 0.76 [0.66, 0.87], P < 0.0001), objective response rate (risk ratio [RR]: 1.36 [1.22, 1.51], P < 0.00001), and disease control rate (RR: 1.06 [1.00, 1.12], P = 0.04). The PFS rates were also higher in the PIBC group at 6 and 18 months. Both groups showed similar results in terms of OS, 3-36 month OS rates, and total AEs. However, the PIBC group exhibited a higher incidence of grade 3-5 AEs, serious AEs, grade 3-5 treatment-related AEs (TRAEs) and serious TRAEs. The most frequent grade 3-5 AEs in the PIBC group included anorexia (36.40%), decreased neutrophil count (16.25%), neutropenia (13.50%), reduced white blood cell count (12.12%), and febrile neutropenia (9.42%).
PIBC appears to be better than PIC for advanced NSCLC offering improved PFS and response rates (ORR and DCR). However, its higher incidence of AEs requires cautious attention.
https://www.crd.york.ac.uk/PROSPERO/view/CRD42024559146, identifier CRD42024559146.
将程序性死亡受体1/程序性死亡配体1（PD-1/PD-L1）抑制剂与化疗联合使用（PIC）是晚期非小细胞肺癌（NSCLC）的标准一线治疗方案。在该方案中加入贝伐单抗（PD-1/PD-L1抑制剂+贝伐单抗+化疗[PIBC]）在临床实践中增强抗肿瘤疗效的潜力仍存在争议。本荟萃分析旨在比较PIBC与PIC的抗肿瘤有效性和安全性。
我们系统检索了六个数据库以确定符合条件的随机对照试验（RCT）。主要结局为总生存期（OS）和无进展生存期（PFS），次要结局包括治疗反应和不良事件（AE）。
分析了三项RCT（IMpower150、jRCT2080224500和ORIENT-31），共纳入1529例患者。PIBC方案显著改善了PFS（风险比[HR]：0.76[0.66，0.87]，P<0.0001）、客观缓解率（RR：1.36[1.22，1.51]，P<0.00001）和疾病控制率（RR：1.06[1.00，1.12]，P = 0.04）。PIBC组在6个月和18个月时的PFS率也更高。两组在OS、3至36个月的OS率和总AE方面结果相似。然而，PIBC组3-5级AE、严重AE、3-5级治疗相关AE（TRAE）和严重TRAE的发生率更高。PIBC组最常见的3-5级AE包括厌食（36.40%）、中性粒细胞计数减少（16.25%）、中性粒细胞减少（13.50%）、白细胞计数减少（12.12%）和发热性中性粒细胞减少（9.42%）。
对于晚期NSCLC，PIBC似乎比PIC更好，可提高PFS和缓解率（ORR和DCR）。然而，其较高的AE发生率需要谨慎关注。
https://www.crd.york.ac.uk/PROSPERO/view/CRD42024559146，标识符CRD42024559146。
