scholarly journals Benefits of local consolidative treatment in oligometastases of solid cancers: a stepwise-hierarchical pooled analysis and systematic review

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Chai Hong Rim ◽  
In-Soo Shin ◽  
Sunmin Park ◽  
Hye Yoon Lee
Keyword(s):  
Observational Studies ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Small Cell ◽  
Cochrane Library ◽  
Small Cell Lung ◽  
Lung Cancers ◽  
Randomized Controlled ◽  
Grade 3 ◽  
Available Information

AbstractWe conducted a meta-analysis of articles published in PubMed, MEDLINE, EMBASE, and Cochrane library to investigate the effectiveness of local consolidative therapy (LCT) against oligometastases. Data from randomized controlled trials (RCTs), balanced studies, and all studies combined were analyzed in a hierarchical manner. Pooled analyses of 31 studies (including seven randomized trials) investigating the effectiveness of LCT on overall survival revealed odds ratios of 3.04, 2.56, and 1.41 for all studies, balanced studies, and RCTs, respectively (all p < 0.05). The benefit of LCT was more prominent in patients with non-small cell lung and colorectal cancers than in those with prostate and small cell lung cancers. Moreover, the benefit of LCT was smaller in patients with high metastatic burdens (p = 0.054). In four of 12 studies with available information, additional grade ≥3 toxicities due to LCTs were reported. Overall, LCT is beneficial for patients with oligometastases, although such benefits are less evident in RCTs than in observational studies. Appropriate LCTs should be carefully selected considering their feasibility, disease type, and metastatic burden.

scholarly journals Benefits of local consolidative treatment in oligometastases of solid cancers: a stepwise-hierarchical pooled analysis and systematic review

2020 ◽  
Author(s):  
Chai Hong Rim ◽  
In-Soo Shin ◽  
Sunmin Park ◽  
Hye Yoon Lee
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Observational Studies ◽  
Progression Free Survival ◽  
Pooled Analysis ◽  
Small Cell ◽  
Cochrane Library ◽  
Small Cell Lung ◽  
One Year

Purpose: Any available evidence regarding the application of local consolidative therapy (LCT) for oligometastases is from phase 2 and observational studies. This study aimed to evaluate the oncologic benefits of LCT in oligometastatic setting. Methods: The MEDLINE, EMBASE, and Cochrane library were searched. We applied stepwise analyses that enabled the evaluation of data from randomized controlled trials (RCTs), balanced studies (e.g. without significant differences regarding major prognosticators between arms), and all studies separately and in a hierarchical manner Results: Thirty one studies including seven randomized trials were reviewed. Pooled analyses of the effect of LCT on overall survival (OS) revealed odds ratios (ORs) of 3.04 (95% confidence interval [CI]: 2.28~4.06, p<0.001), 2.56 (95% CI: 1.79~3.66, p<0.001), and 1.41 (95% CI: 1.02~1.95, p=0.041) for all studies, balanced studies, and RCTs, respectively. The corresponding ORs for progression free survival were 2.82 (95% CI: 1.96~4.06, p<0.001), 2.32 (95% CI: 1.60~3.38, p<0.001), and 1.39 (95% CI: 1.09~1.80, p=0.009), respectively. The benefit of LCT was higher in non small cell lung cancer (OR: 3.14, p<0.001; pooled 2 year OS: 65.2% vs. 37.0%) and colorectal cancer (OR: 4.11, p=0.066; pooled two year OS: 66.2% vs. 33.2%) than in prostate (OR: 1.87, p=0.006; pooled three year OS: 95.6% vs. 92.6%) and small cell lung cancer (OR: 1.04, p=0.942; pooled one year OS: 60.7% vs. 42.8%). Complications were generally mild. Conclusion: LCT provides oncologic benefits in the oligometastatic setting, although such benefits were less evident in RCTs than in data from observational studies. The appropriate LCTs should be carefully selected, considering their feasibility and disease types.

PD-1/PD-L1 inhibitors plus chemotherapy versus bevacizumab plus chemotherapy as first-line treatment for advanced nonsquamous non-small cell lung cancer: A Bayesian network meta-analysis of randomized controlled trials.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e21152-e21152
Author(s):  
Zhibo Zhang ◽  
Jinzhao Zhai ◽  
Xiang Yan ◽  
Fan Zhang ◽  
Xiaoyan Li ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Meta Analysis ◽  
Small Cell ◽  
Controlled Trials ◽  
Line Treatment ◽  
Small Cell Lung ◽  
First Line ◽  
Randomized Controlled ◽  
Grade 3 ◽  
First Line Treatment

e21152 Background: Chemotherapy in combination with PD-1/PD-L1 inhibitor or bevacizumab have demonstrated superior efficacy to chemotherapy in the first-line treatment for non-squamous non-small-cell lung cancer (NS-NSCLC). However, there has been no randomized study comparing PD-1/PD-L1 inhibitors plus chemotherapy (immune-chemo) with bevacizumab plus chemotherapy (bev-chemo). Thus, we performed this network meta-analysis (NMA) to evaluate the comparative efficacy and safety of immune-chemo and bev-chemo as first-line treatment for NS-NSCLC. Methods: The randomized controlled trials (RCTs) were identified by searching PubMed, Embase, the Cochrane library, and conference abstracts until Oct 2020. Bayesian NMA with fixed effect consistency model was applied to estimate hazard ratio (HR) and Odds ratio (OR) with their 95% confidence intervals (CIs). The outcomes included progression-free survival (PFS), overall survival (OS), overall response rate (ORR), and grade ≥3 treatment-related adverse events (TRAEs). Results: 15 RCTs involving 6541 advanced NS-NSCLC patients were eligible for analysis. For OS, immune-chemo (HR 0.70, 95% CI 0.64-0.79) and bev-chemo (0.87, 0.79-0.95) significantly prolonged survival compared with chemotherapy. For PFS, immune-chemo (0.58, 0.53-0.62) and bev-chemo (0.66, 0.61-0.71) were significantly superior to chemotherapy. For ORR, immune-chemo (2.42, 1.93-3.08) and bev-chemo (2.27, 1.75-2.92) were associated with better benefits than chemotherapy. However, immune-chemo (1.61, 1.08-2.35) and bev-chemo (1.83, 1.08-2.90) increased grade ≥3 TRATEs compared with chemotherapy. The results of Bayesian NMAs shown that immune-chemo (PFS: 0.88[0.80-0.97]; OS: 0.81[0.72-0.92]) was associated with better outcomes than bev-chemo, while there were no significant differences in ORR and the risk of grade ≥3 TRATEs (Table). Conclusions: Immune-chemo and bev-chemo are superior to chemotherapy in first-line treatment of NS-NSCLC. Immune-chemo could significantly improve clinical outcomes compared with bev-chemo without higher severe TRAEs. [Table: see text]

scholarly journals A systematic review and meta-analysis of treatment-related toxicities of curative and palliative radiation therapy in non-small cell lung cancer

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
M. Or ◽  
B. Liu ◽  
J. Lam ◽  
S. Vinod ◽  
W. Xuan ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Systematic Review ◽  
Decision Making ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Meta Analysis ◽  
Small Cell ◽  
Small Cell Lung ◽  
Cardiac Events ◽  
Grade 3

AbstractTreatment-related toxicity is an important component in non-small cell lung cancer (NSCLC) management decision-making. Our aim was to evaluate and compare the toxicity rates of curative and palliative radiotherapy with and without chemotherapy. This meta-analysis provides better quantitative estimates of the toxicities compared to individual trials. A systematic review of randomised trials with > 50 unresectable NSCLC patients, treated with curative or palliative conventional radiotherapy (RT) with or without chemotherapy. Data was extracted for oesophagitis, pneumonitis, cardiac events, pulmonary fibrosis, myelopathy and neutropenia by any grade, grade ≥ 3 and treatment-related deaths. Mantel–Haenszel fixed-effect method was used to obtain pooled risk ratio. Forty-nine trials with 8609 evaluable patients were included. There was significantly less grade ≥ 3 acute oesophagitis (6.4 vs 22.2%, p < 0.0001) and any grade oesophagitis (70.4 vs 79.0%, p = 0.04) for sequential CRT compared to concurrent CRT, with no difference in pneumonitis (grade ≥ 3 or any grade), neutropenia (grade ≥ 3), cardiac events (grade ≥ 3) or treatment-related deaths. Although the rate of toxicity increased with intensification of treatment with RT, the only significant difference between treatment regimens was the rate of oesophagitis between the use of concurrent and sequential CRT. This can aid clinicians in radiotherapy decision making for NSCLC.

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