文章：

不可切除胸膜间皮瘤一线治疗方案的荟萃分析：基于六项随机对照试验重建个体患者数据的间接比较

A Meta-Analysis of First-Line Treatments for Unresectable Pleural Mesothelioma: Indirect Comparisons from Reconstructed Individual Patient Data of Six Randomized Controlled Trials

原文发布日期：3 February 2025

DOI: 10.3390/cancers17030503

类型: Article

开放获取: 是

英文摘要：

Background: In unresectable pleural mesothelioma, pemetrexed+cisplatin as first line is considered the standard of care, but novel treatments have been recently proposed. Methods: Our objective was to compare, albeit indirectly, the results of randomized controlled trials on overall survival (OS). The IPDfromKM method was employed for reconstruct individual patient data (IPD) from the graphs of Kaplan–Meier curves. Cox statistics was run to estimate hazard ratios (HRs). Results: After a literature search on Medline (via PubMed) and Scopus databases, six randomized controlled trials were identified in which five new treatments (nivolumab plus ipilimumab, bevacizumab plus pemetrexed plus cisplatin, chemotherapy plus pembrolizumab, ONCOS-102 plus pemetrexed plus cisplatin/carboplatin and cediranib plus pemetrexed+cisplatin with maintenance with cediranib) were evaluated. In five trials, pemetrexed plus cisplatin was the standard of care given to the control arms. Nivolumab plus ipilimumab, bevacizumab plus pemetrexed plus cisplatin and chemotherapy plus pembrolizumab showed a significantly better OS compared with controls. ONCOS-102 plus pemetrexed plus cisplatin/carboplatin did not significantly improve OS. In contrast, OS worsened with cisplatin alone and with cediranib plus pemetrexed+cisplatin with maintenance with cediranib. Discussion: Our analysis indicates that, in patients with unresectable pleural mesothelioma, three of the five novel treatments provided a significant survival benefit compared with the standard of care. Further research is needed to confirm the OS benefit found in our analysis with some treatments, whereas cisplatin alone and cediranib plus pemetrexed+cisplatin with maintenance with cediranib do not seem to deserve further research.

摘要翻译： 

背景：对于不可切除的胸膜间皮瘤，培美曲塞联合顺铂作为一线治疗方案被视为标准疗法，但近期已有新型治疗方案被提出。方法：本研究旨在通过间接比较的方式，评估不同随机对照试验中关于总生存期（OS）的结果。我们采用IPDfromKM方法，基于Kaplan-Meier曲线图重建个体患者数据（IPD），并运用Cox统计模型估算风险比（HRs）。结果：通过对Medline（通过PubMed）和Scopus数据库进行文献检索，共识别出六项随机对照试验，其中评估了五种新型治疗方案（纳武利尤单抗联合伊匹木单抗、贝伐珠单抗联合培美曲塞联合顺铂、化疗联合帕博利珠单抗、ONCOS-102联合培美曲塞联合顺铂/卡铂，以及西地尼布联合培美曲塞+顺铂并维持西地尼布治疗）。在五项试验中，对照组均采用培美曲塞联合顺铂作为标准疗法。与对照组相比，纳武利尤单抗联合伊匹木单抗、贝伐珠单抗联合培美曲塞联合顺铂以及化疗联合帕博利珠单抗在总生存期方面表现出显著优势。ONCOS-102联合培美曲塞联合顺铂/卡铂未能显著改善总生存期。相反，单独使用顺铂以及西地尼布联合培美曲塞+顺铂并维持西地尼布治疗反而导致总生存期恶化。讨论：我们的分析表明，在不可切除的胸膜间皮瘤患者中，五种新型治疗方案中有三种相较于标准疗法提供了显著的生存获益。需要进一步研究以确认本分析中某些治疗方案带来的总生存期获益，而单独使用顺铂以及西地尼布联合培美曲塞+顺铂并维持西地尼布治疗似乎不值得进一步研究。

原文链接：

A Meta-Analysis of First-Line Treatments for Unresectable Pleural Mesothelioma: Indirect Comparisons from Reconstructed Individual Patient Data of Six Randomized Controlled Trials