Cheng Cong-Cong, Ma Lin-Jie, Pang Xu-Mei, Huang Tao-Sheng, Wang Ming-Fang, Xu Ji-Ying, Wang Run-Qing, Chen Xi, Sun Kai, Zhao Wen-Xiang, Yan Min, Wang Peng
Department of Oncology, Yidu Central Hospital of Weifang, Qingzhou, China.
J Thorac Dis. 2025 Aug 31;17(8):6201-6213. doi: 10.21037/jtd-2025-1306. Epub 2025 Aug 25.
Given the high invasiveness of extensive-stage small-cell lung cancer (ES-SCLC), the limited treatment options available, and the definite efficacy of poly ADP-ribose polymerase inhibitors (PARPis) in the treatment of diverse cancers, such as metastatic castration-resistant prostate cancer, recurrent ovarian cancer, and advanced breast cancer, we performed a meta-analysis to evaluate the efficacy and toxicity of PARPis in the treatment of ES-SCLC.
A systematic literature search of online databases was conducted to retrieve relevant articles published before March 2025. Six articles on randomized controlled trials (RCTs) involving 924 patients were included in the meta-analysis. The relative risk (RR)/odds ratio (OR) data were extracted from the RCTs as the research objects to conduct an integrated analysis via RevMan5.4.
The meta-analysis illustrated that PARPis significantly improved the objective response rate (ORR) [OR =2.03, 95% confidence interval (CI): 1.26-3.28] and progression-free survival (PFS) [hazard ratio (HR) =0.72, 95% CI: 0.63-0.81] of the ES-SCLC patients between the included 6 RCTS, especially those with positive (+) expression (HR =0.65, 95% CI: 0.51-0.82), but it did not result in any overall survival (OS) benefit. Additionally, the application of PARPis resulted in higher rates of adverse events (AEs), including anemia, leukopenia, thrombocytopenia, vomiting, fatigue, and nausea, but these AEs were not life-threatening.
Our findings confirmed that PARPis represent an effective treatment option for ES-SCLC patients, especially those with + expression. Our meta-analysis revealed no apparent increase in OS in these patients; however, this might be due to the lack of sufficient data in the clinical trials; thus, more extensive studies with longer follow-up periods need to be conducted.
鉴于广泛期小细胞肺癌（ES-SCLC）的高侵袭性、可用治疗选择有限，以及聚ADP-核糖聚合酶抑制剂（PARPis）在治疗多种癌症（如转移性去势抵抗性前列腺癌、复发性卵巢癌和晚期乳腺癌）中的明确疗效，我们进行了一项荟萃分析，以评估PARPis治疗ES-SCLC的疗效和毒性。
对在线数据库进行系统文献检索，以检索2025年3月之前发表的相关文章。纳入荟萃分析的有6篇关于随机对照试验（RCT）的文章，涉及924例患者。从RCT中提取相对风险（RR）/比值比（OR）数据作为研究对象，通过RevMan5.4进行综合分析。
荟萃分析表明，在纳入的6项RCT中，PARPis显著提高了ES-SCLC患者的客观缓解率（ORR）[OR =2.03，95%置信区间（CI）：1.26 - 3.28]和无进展生存期（PFS）[风险比（HR） =0.72，95% CI：0.63 - 0.81]，尤其是那些具有阳性（+）表达的患者（HR =0.65，95% CI：0.51 - 0.82），但未带来任何总生存期（OS）获益。此外，PARPis的应用导致不良事件（AE）发生率更高，包括贫血、白细胞减少、血小板减少、呕吐、疲劳和恶心，但这些不良事件并不危及生命。
我们的研究结果证实，PARPis是ES-SCLC患者，尤其是那些具有+表达患者的有效治疗选择。我们的荟萃分析显示这些患者的OS无明显增加；然而，这可能是由于临床试验中缺乏足够的数据；因此，需要进行更广泛、随访期更长的研究。
