Hetta Helal F, Ali Mostafa A Sayed, Alqifari Saleh F, Salem Hoda A, Qasem Khulood A, Alanazi Fawaz E, Alhowiti Amirah, Alatawi Amirah M, Mirghani Hyder, Alrasheed Tariq, Bukhari Salwa Q, Almazyad Khalid A, Alhumaid Sultan A, Abd Ellah Noura H, Aljohani Hashim M, Ramadan Yasmin N, Sayad Reem
Division of Microbiology, Immunology and Biotechnology, Department of Natural Products and Alternative Medicine, Faculty of Pharmacy, University of Tabuk, Tabuk 71491, Saudi Arabia.
Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk 71491, Saudi Arabia.
Pharmaceuticals (Basel). 2025 Jun 28;18(7):974. doi: 10.3390/ph18070974.
: Non-small-cell lung cancer (NSCLC) frequently metastasizes to the brain, significantly impacting patient prognosis and quality of life. Anlotinib, a novel tyrosine kinase inhibitor, has shown promise in treating NSCLC with brain metastasis. So, we aimed to evaluate the clinical efficacy of anlotinib and various types of radiotherapy combinations used to treat NSCLC patients with brain metastasis regarding overall survival and the treatment of internal and external lesions. : A comprehensive literature search was conducted in the databases PubMed, Scopus, WoS, MedLine, and Cochrane Library up to April 2024. Studies assessing the efficacy of anlotinib combined with whole-brain radiotherapy (WBRT), stereotactic radiosurgery (SRS), or other radiotherapy modalities in NSCLC patients with brain metastasis were included. The primary outcomes were (a) the efficacy of anlotinib and radiotherapy on the intracranial lesions and OS and (b) the effectiveness of combined anlotinib and radiotherapy versus radiotherapy alone in NSCLC patients with brain metastasis. The secondary outcome was the efficacy of anlotinib and radiotherapy on extracranial progression. We used a combination of keywords and MeSH terms including 'non-small cell lung cancer' OR 'NSCLC', 'brain metastases', 'anlotinib', 'radiotherapy', 'radiation therapy', and 'combined treatment', among others. Boolean operators (AND, OR) were applied as appropriate to optimize the search strategy across databases. : Nine studies met the inclusion criteria, comprising 210 patients in the combination group and 228 patients in the radiotherapy alone group. The combination of anlotinib with radiotherapy showed a significant improvement in iPFS compared to radiotherapy alone, with a pooled risk ratio (RR) for iORR of 1.18 (95% CI: 1.00-1.39) and a pooled SMD for OS of 0.03 (95% CI: -0.29, 0.36). Radiotherapy combined with anlotinib also demonstrated enhanced intracranial and extracranial control rates. : Anlotinib combined with radiotherapy, especially WBRT, offers a promising treatment strategy for NSCLC patients with brain metastasis, improving intracranial control. Further large-scale randomized controlled trials are needed to confirm these findings and optimize treatment protocols.
非小细胞肺癌（NSCLC）常发生脑转移，严重影响患者预后和生活质量。安罗替尼是一种新型酪氨酸激酶抑制剂，在治疗伴有脑转移的NSCLC方面显示出前景。因此，我们旨在评估安罗替尼与各种放疗联合方案用于治疗伴有脑转移的NSCLC患者的总生存期以及对颅内和颅外病灶治疗的临床疗效。
截至2024年4月，我们在PubMed、Scopus、WoS、MedLine和Cochrane图书馆数据库中进行了全面的文献检索。纳入评估安罗替尼联合全脑放疗（WBRT）、立体定向放射外科（SRS）或其他放疗方式治疗伴有脑转移的NSCLC患者疗效的研究。主要结局为：（a）安罗替尼和放疗对颅内病灶及总生存期的疗效；（b）安罗替尼与放疗联合治疗与单纯放疗相比，对伴有脑转移的NSCLC患者的有效性。次要结局是安罗替尼和放疗对颅外进展的疗效。我们使用了包括“非小细胞肺癌”或“NSCLC”、“脑转移”、“安罗替尼”、“放疗”、“放射治疗”和“联合治疗”等在内的关键词和医学主题词（MeSH）术语组合。酌情应用布尔运算符（AND、OR）以优化跨数据库的检索策略。
9项研究符合纳入标准，联合治疗组有210例患者，单纯放疗组有228例患者。与单纯放疗相比，安罗替尼与放疗联合治疗在颅内无进展生存期（iPFS）方面有显著改善，颅内客观缓解率（iORR）的合并风险比（RR）为1.18（95%CI：1.00 - 1.39），总生存期（OS）的合并标准化均数差（SMD）为0.03（95%CI： - 0.29，0.36）。放疗联合安罗替尼还显示出更高的颅内和颅外控制率。
安罗替尼联合放疗，尤其是联合WBRT，为伴有脑转移的NSCLC患者提供了一种有前景的治疗策略，可改善颅内控制。需要进一步的大规模随机对照试验来证实这些发现并优化治疗方案。
