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Efficacy and safety of angiogenesis inhibitors in small-cell lung cancer
Heng Lin1,2, Lina Li1, Shuimei Luo1
1Department of Chemotherapy, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China.
Objective:
The purpose of this study was to investigate the efficacy and safety of angiogenesis inhibitors for small-cell lung cancer (SCLC).
Methods:
Totally, 16 controlled trials (1898 cases) involving angiogenesis inhibitors plus chemotherapy (ACT group) versus chemotherapy alone group (CT group) were identified from PubMed, EMBASE, Cochrane Library and Wanfang Data before March 2016.
Results:
Compared with CT group, ACT group obtained a significant benefit on objective response rate (ORR) (RR = 1.34; 95% CI = 1.19-1.51; P < 0.00001) and a trend of prolonging progression-free survival (PFS) (HR = 0.86; 95% CI = 0.73-1.01; P = 0.07) without improving overall survival (OS) (HR = 1.05; 95% CI = 0.94-1.17; P = 0.36). Remarkably, subgroup analysis showed that the antibodies targeting VEGF significantly prolonged PFS (HR = 0.76; 95% CI = 0.64-0.90; P = 0.001). With regard to toxicity, there was no significant difference in severe adverse events (AEs, Grade≥3) between two groups except that gastrointestinal symptom, hypertension, metabolic disorders, neurology and pain were higher in ACT group.
Conclusion:
Compared with chemotherapy alone, antibodies targeting VEGF plus chemotherapy significantly improved ORR and prolonged PFS with an acceptable toxicity profile for patients with SCLC. Therefore, angiogenesis inhibitors, especially antibodies targeting VEGF, combining with chemotherapy may be a potential promising strategy in managing SCLC.
Insights
Angiogenesis inhibitors combined with chemotherapy show promise for small-cell lung cancer (SCLC), improving response rates and progression-free survival. While overall survival was not improved, VEGF-targeted therapies offer a potential new strategy with acceptable safety.
Area of Science:
- Oncology
- Pharmacology
- Clinical Trials
Background:
- Small-cell lung cancer (SCLC) remains a challenging malignancy with limited treatment options.
- Angiogenesis plays a critical role in tumor growth and metastasis in SCLC.
Purpose of the Study:
- To evaluate the efficacy and safety of angiogenesis inhibitors when used in combination with chemotherapy for SCLC.
- To compare outcomes of angiogenesis inhibitor plus chemotherapy (ACT) versus chemotherapy alone (CT).
Main Methods:
- A systematic review and meta-analysis of 16 controlled trials involving 1898 patients.
- Searched PubMed, EMBASE, Cochrane Library, and Wanfang Data for relevant studies published before March 2016.
Main Results:
- The ACT group demonstrated a significant improvement in objective response rate (ORR) compared to the CT group (RR = 1.34).
- A trend towards prolonged progression-free survival (PFS) was observed in the ACT group (HR = 0.86), though overall survival (OS) was not significantly improved (HR = 1.05).
- Subgroup analysis revealed that vascular endothelial growth factor (VEGF) targeting antibodies significantly prolonged PFS (HR = 0.76) with an acceptable safety profile, despite increased gastrointestinal symptoms, hypertension, and pain in the ACT group.
Conclusions:
- Angiogenesis inhibitors, particularly VEGF-targeting antibodies, combined with chemotherapy significantly enhance ORR and PFS in SCLC patients.
- This combination therapy presents a promising and viable strategy for managing SCLC, offering an acceptable toxicity profile.
