针对NSCLC的新辅助化疗免疫疗法:系统性审查和元分析
Mark Sorin1,2,3, Connor Prosty3, Louis Ghaleb3
1Rosalind and Morris Goodman Cancer Institute, McGill University, Montréal, Quebec, Canada.
JAMA oncology
|March 21, 2024
概括
与单独的化疗相比,新辅助化疗免疫疗法显著改善了非小细胞肺癌 (NSCLC) 的结果. 这种方法甚至有利于具有较低编程细胞死亡1联体1 (PD-L1) 表达率的患者,提高无事件生存率.
科学领域:
- 在瘤学瘤学.
- 胸部外科手术 胸部外科手术
- 医学研究 医学研究
背景情况:
- 没有全面的元分析评估了非小细胞肺癌 (NSCLC) 中的新辅助化学免疫疗法.
- 关于新辅助化学免疫疗法在NSCLC患者的疗效存在争议,这些患者的编程细胞死亡11 (PD-L1) 水平低于1%.
研究的目的:
- 为了比较新辅助化学免疫疗法与NSCLC中的化疗.
- 评估不良事件,手术,病理和疗效结果的差异.
- 综合来自随机和非随机临床试验的证据.
主要方法:
- 针对至少10名患者的临床试验,对MEDLINE和Embase (2013年1月~2023年10月) 的系统文献搜索.
- 排除对新辅助放射治疗,化学放射治疗,向疗法或免疫疗法单疗法的研究.
- 合并的手术,病理,疗效终点和不良事件的随机效应元分析.
主要成果:
- 分析了43项涉及5431名患者的试验,其中包括8项随机试验 (3387名患者).
- 在随机试验中,新辅助化学免疫疗法显示出更高的整体存活率 (HR,0.65),无事件存活率 (HR,0.59),主要病理反应 (RR,3.42),和完整的病理反应 (RR,5.52).
- 患有PD-L1水平<1%的患者在接受新辅助化疗免疫疗法时显示出显著的无事件生存益处 (HR,0.74).
结论:
- 新辅助化学免疫疗法在NSCLC的关键手术,病理和疗效方面优于新辅助化学疗法.
- 切除性NSCLC和PD-L1水平<1%的患者可能受益于新辅助化疗免疫疗法,特别是在无事件生存方面.
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