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在以前的免疫检查点抑制剂失败后,针对非小细胞肺癌的系统治疗选择:基于随机对照试验的贝叶斯网络元分析

Kang Wang¹, Zhenxue Fu², Guanxing Sun¹

¹Department of Oncology, Zaozhuang Municipal Hospital, Zaozhuang, 277100, China.

|June 27, 2024

概括

对于在免疫检查点抑制剂 (ICI) 后进展的非小细胞肺癌 (NSCLC),氨酸激酶抑制剂加上化疗 (TKI+Chemo) 改善了无进展生存率和反应率. ICI加TKI (ICI+TKI) 提供了最长的整体存活期,而ICI加抗血管原抗体 (ICI+Antiangio-Ab) 显示了最好的安全性.

科学领域:

在瘤学瘤学.
免疫治疗是一种免疫疗法.
药理学药理学是指药理学的学科.

背景情况:

免疫检查点抑制剂 (ICI) 改善了非小细胞肺癌 (NSCLC) 的存活率.
在ICI治疗后经历疾病进展的NSCLC患者的最佳系统治疗策略仍未确定.
这项研究解决了在ICI失败后的高级NSCLC中需要基于证据的治疗建议的需求.

研究的目的:

进行网络元分析 (NMA),比较ICI失败后NSCLC的各种系统治疗方法.
评估有效性结果,包括无进展生存期 (PFS),总生存期 (OS) 和客观反应率 (ORR).
评估不同治疗方案的安全概况,特别是不同治疗方案的不良事件 (AE).

主要方法:

在PubMed,Embase,Web of Science和Cochrane图书馆数据库中进行了系统的文献搜索.
包括二期和三期随机对照试验 (RCT),比较ICI失败后的全身疗法.
使用贝叶斯网络元分析,使用R软件对比基于PFS和OS的危险比率 (HR),ORR的几率比率 (OR) 和AE的相对风险 (RR) 的治疗方法.

主要成果:

分析了6项涉及1322名患者的研究,比较了ICI+化疗,ICI+抗血管原单克隆抗体 (ICI+Antiangio-Ab),ICI+铁酸激酶抑制剂 (ICI+TKI),铁酸激酶抑制剂+化疗 (TKI+化疗),标准护理 (SOC) 和化疗 (化疗) 等治疗方法.
TKI+Chemo显示出优异的PFS和ORR (SUCRA分别为99.7%和88.2%).
ICI+TKI获得了最长的OS (SUCRA 82.7%),而ICI+Antiangio-Ab在任何等级,等级3+和治疗中止方面表现出最好的安全概况 (SUCRA分别为95%,82%和93%).

结论:

对于在ICI上进展的NSCLC患者,建议TKI+Chemo用于改善PFS和ORR.
ICI+TKI与最长的操作系统相关,提供生存益处.
ICI+Antiangio-Ab提供了最有利的安全概况,对于患者的耐受性和治疗坚持至关重要.

关键词:

贝叶斯语贝叶斯语贝叶斯语贝叶斯语疾病进展疾病进展.免疫检查点抑制剂免疫检查点抑制剂非小细胞肺癌是非小细胞肺癌.铁氨酸激酶抑制剂铁氨酸激酶抑制剂

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