在测试免疫检查点抑制剂的随机临床试验中,整体生存的替代终点:系统性审查和元分析
Isabella Sala1,2, Eleonora Pagan1, Laura Pala3
1Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy.
Frontiers in immunology
|February 13, 2024
概括
在免疫检查点抑制剂试验中,总生存的最佳代用终点是无进展生存 (PFS). 改性PFS (mPFS) 和受限平均存活时间 (RMST) 不是这些癌症治疗的可靠替代品.
科学领域:
- 在瘤学瘤学.
- 临床试验 临床试验
- 免疫治疗是一种免疫疗法.
背景情况:
- 免疫检查点抑制剂 (ICI) 已经彻底改变了癌症治疗,但在随机对照试验 (RCT) 中为整体生存 (OS) 选择最佳代理终点仍然存在争议.
- 准确的代用终点对于加速药物开发和评估高级固体瘤治疗疗效至关重要.
研究的目的:
- 系统地评估ICI的RCT中OS的无进展生存期 (PFS) 和修改后生存期 (mPFS) 的代孕值.
- 为了比较不同的治疗效果指标,包括危险比率 (HR) 和受限平均生存时间 (rRMST) 的比率.
- 确定最佳的替代终点和度量,以捕捉各种ICI治疗环境中对OS的治疗效应.
主要方法:
- 在先进的实体瘤中对测试PD-L和CTLA-4抑制剂的RCT进行系统的文献搜索.
- 纳入标准:具有≥100名患者的RCT,评估ICI作为单疗法或组合治疗.
- 进行元分析以比较PFS和mPFS在OS的代孕,使用HR用于OS和HR/rRMST用于PFS/mPFS.
主要成果:
- 分析包括61个RCT (36,034名患者).
- 对于ICI加化疗,HRPFS (R2=0.74) 和HRmPFS (R2=0.81) 显示了强大的代孕对OS.
- 对于ICI单疗,HRPFS (R2=0.58) 是最好的替代品;其他组合显示较弱的关联 (R2=0.01-0.22).
结论:
- 在ICI试验中,OS替代终点的有效性在很大程度上取决于特定的治疗背景.
- 在ICI试验中,HRPFS是OS最可靠的替代终点,其表现优于mPFS和rRMST.
- 目前的证据不支持mPFS或rRMST作为OS的有效替代品.
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