Treatments For Relapsed Or Refractory Follicular Lymphoma (RRFL): Results Of a Systematic Literature Review (SLR) and Meta-Analysis

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5106-5106
Author(s):  
Rachel Lee Police ◽  
Peter C Trask ◽  
Ann Colosia ◽  
Robert Olivares ◽  
Shahnaz Khan ◽  
...  
Keyword(s):  
Follicular Lymphoma ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Objective Response ◽  
Cochrane Library ◽  
Cell Transplant ◽  
Limited Information ◽  
Grade 3 ◽  
The Impact ◽  
Indirect Comparisons

Abstract Background Follicular lymphoma (FL), the most frequent form of indolent NHL (iNHL), accounts for 20% to 30% of non-Hodgkin lymphomas (NHL). Median survival is 8–15 years (yrs) for patients (pts) with advanced disease. Approximately 2/3 of pts relapse or become refractory to 1st line treatment. Progression-free survival (PFS) for pts with RRFL is usually less than 2 yrs. This SLR examined current literature on RRFL, comparing the efficacy of treatments by meta-analysis where possible. Methods PubMed, Cochrane Library, and Embase were systematically searched for studies on the efficacy and safety of treatments for RRFL published from 1997 to August 2, 2012. In addition, conference abstracts, reference lists of included articles, recent reviews, and the Clinicaltrials.gov database were searched for otherwise unpublished comparative studies. Main efficacy outcomes were objective response rate (ORR), complete response, partial response, duration of response, PFS, and overall survival (OS). Safety endpoints were grade 3/4 toxicities and treatment withdrawals for toxicity. Studies were selected if they reported on RRFL after ≥ 1 standard treatment in pts ineligible for stem cell transplant and if they were specific to or reported FL outcomes separately. We used the Bucher method for conducting adjusted indirect comparisons. Results 3,308 publications of potential interest were identified; 280 provided relevant data for iNHL; 29 reported on 23 randomized clinical trials (RCTs) in iNHL; 10 were specific to FL and 5 included FL findings in a mixed histology population. OS and PFS were infrequently reported. Criteria for relapsed or refractory disease were often not defined, with only 8 studies providing varying definitions. The most commonly evaluated therapy in patients with FL was rituximab (R) either alone or with bortezomib (B) or lenalidomide (L). ORR, reported in 5 studies, ranged from 49% to 93%. Median PFS in 5 studies ranged from 10 to 25 months but was >50 months for R-CHOP followed by R maintenance. Median OS was not reported, but OS at 1-, 2-, or 3-yrs was reported in several studies. Efficacy results are shown in Table 1. Grade 3/4 toxicities included hematological events (anemia, neutropenia, thrombocytopenia) in 8%-77% of pts. Frequent non-hematological events (≥ 5% pts) included fatigue, diarrhea, and infection. Overlapping treatments were identified in 4 FL trials in which R was identified as a common comparator allowing indirect comparisons via meta-analysis. The ratios of ORR for R + B, R + S, and O were all clinically and significantly higher than for D (Figure 1). No other comparisons were significantly different. Conclusions This SLR found that while rituximab contributes substantially to the efficacy of treatment in pts with RRFL, a need for more effective treatments remains. The relatively small number of RCTs, few overlapping treatment arms, and variability in endpoints studied make it difficult to formally compare available therapies or treatments under developments for RRFL. Significant variability in RCT features (infrequent reporting of OS/PFS, limited information on prior treatments/responses or definition of relapse/refractory) are further challenges to meaningful comparisons. Additional well designed RCTs are needed to fully understand the impact of more recently developed therapies. This research was supported by funding from Sanofi. Disclosures: Police: RTI Health Solutions: Employment. Trask:Sanofi: Employment. Colosia:RTI Health Solutions: Employment. Olivares:Sanofi: Employment. Khan:RTI Health Solutions: Employment. Abbe:Sanofi: Employment. Njue:RTI Health Solutions: Employment. Wang:RTI Health Solutions: Employment. Kaye:RTI Health Solutions: Employment. Ruiz-Soto:Sanofi: Employment.

scholarly journals The Optimal Time of Applying Enteral Immunonutrition in Esophageal Cancer Patients Receiving Esophagectomy: A Network Meta-Analysis of Randomized Clinical Trials

2021 ◽  
Author(s):  
Xu Tian ◽  
Yan-Fei Jin ◽  
Zhao-Li Zhang ◽  
Hui Chen ◽  
Wei-Qing Chen ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Cancer Patients ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Infectious Complications ◽  
Cochrane Library ◽  
Optimal Time ◽  
Registration Number ◽  
Meta Analyses ◽  
The Impact

Abstract Background: Enteral immunonutrition (EIN) has been extensively applied in cancer patients, however its role in esophageal cancer (EC) patients receiving esophagectomy remains unclear. We performed this network meta-analysis to investigate the impact of EIN on patients undergoing surgery for EC and further determine the optimal time of applying EIN.Methods: We searched PubMed, EMBASE, Cochrane library, and China National Knowledgement Infrastructure (CNKI) to identify eligible studies. Categorical data was expressed as the odds ratio with 95% confidence interval (CI), and continuous data was expressed as mean difference (MD) with 95% CI. Pair-wise and network meta-analysis was performed to evaluate the impact of EIN on clinical outcomes using RevMan 5.3 and ADDIS V.1.16.8 softwares. The surface under the cumulative ranking curve (SUCRA) was calculated to rank all nutritional regimes.Results: Total 14 studies involving 1071 patients were included. Pair-wise meta-analysis indicated no difference between EIN regardless of the application time and standard EN (SEN), however subgroup analyses found that postoperative EIN was associated with decreased incidence of total infectious complications (OR=0.47; 95%CI=0.26 to 0.84; p=0.01) and pneumonia (OR=0.47; 95%CI=0.25 to 0.90; p=0.02) and shortened LOH (MD=-1.01; 95%CI=-1.44 to -0.57; p<0.001) compared to SEN, which were all supported by network meta-analyses. Ranking probability analysis further indicated that postoperative EIN has the highest probability of being the optimal option in terms of these three outcomes.Conclusions: Postoperative EIN should be preferentially utilized in EC patients undergoing esophagectomy because it has optimal potential of decreasing the risk of total infectious complications and pneumonia and shortening LOH.OSF registration number: 10.17605/OSF.IO/KJ9UY.

scholarly journals The Impact of Javanica Oil Emulsion Injection on Chemotherapy Efficacy and Cellular Immune Indicators in Patients with Advanced NSCLC: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 2019 ◽  
pp. 1-12
Author(s):  
Huilin Xu ◽  
Zhucheng Yin ◽  
Anbing He ◽  
Dedong Cao
Keyword(s):  
Advanced Nsclc ◽  
Karnofsky Performance Status ◽  
Meta Analysis ◽  
Objective Response ◽  
Cochrane Library ◽  
Combination Group ◽  
Control Group ◽  
Oil Emulsion ◽  
Standard Mean Difference ◽  
The Impact

Background. This meta-analysis aimed to evaluate the efficacy and safety of Javanica oil emulsion injection (JOI) combined with chemotherapy versus chemotherapy in patients with advanced non-small-cell lung cancer (NSCLC). Methods. Electronic databases including EMBASE, PUBMED, the Cochrane library, and Chinese Biological Medical disc (CBM) were searched until May 2018. The clinical trials reporting efficacy and immune function of JOI combined with chemotherapy versus chemotherapy in advanced NSCLC were included according to the inclusion and exclusion criteria. Stata 11 and RevMan 5.3 were used for meta-analysis. Results. Twenty-four studies involving 2089 cases were included. The results of the meta-analysis showed that there were significant differences in objective response rate (risk ratio (RR) = 1.17; 95% confidence interval (CI): 1.05–1.29; P<0.05), improvement in Karnofsky Performance Status (standard mean difference (SMD) = 1.59; 95% CI: 1.41–1.77; P<0.01), incidence of adverse events (RR = 0.78; 95% CI: 0.7–0.87; P<0.05), percentage changes of CD3+ cells (SMD = 2.0; 95% CI: 1.49–2.50; P<0.01), CD4+ cells (SMD = 1.55; 95% CI, 1.2–1.9; P<0.01), natural killer cells (SMD = 1.98; 95% CI: 1.15–2.82; P<0.01), but not CD8+ (SMD = −1.44; 95% CI: −4.53–1.65; P=0.36), and value of CD4+/CD8+ (SMD = 0.32; 95% CI: 0.28–0.36; P<0.01) between the JOI combination group and control group. Funnel plot and Begg’s and Egger’s analysis indicated that there was no significant publication bias (P>0.05). Conclusions. JOI may be effective to improve the efficacy of chemotherapy in advanced NSCLC patients, accompanied with better levels of immune cells.

scholarly journals Acupuncture Treatments for Post-stroke Depression: A Systematic Review and Network Meta-analysis

2021 ◽  
Author(s):  
Lam Wai Ching ◽  
Hui Juan Li ◽  
Jianwen Guo ◽  
Liang Yao ◽  
Janita Chau ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Rating Scale ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Depression Symptoms ◽  
Post Stroke ◽  
Significant Difference ◽  
Post Stroke Depression ◽  
The Impact

Abstract Background: Depression is one of the most common complications after stroke, with a prevalence of 30-33%. Patients with post-stroke depression (PSD) usually experience anxiety, hopelessness, and insomnia, which have a negative impact on their daily activities and post-stroke rehabilitation. In this review, we aimed to explore the impact of acupuncture in alleviating symptoms of PSD and to evaluate the difference in effectiveness between acupuncture combined with pharmacotherapies and various non-pharmacotherapies in order to provide guides and advice for clinical personnel. Methods: Six databases (Cochrane Library, PubMed, EMBASE, China National Knowledge Infrastructure, Wanfang Database, Chongqing VIP Database) and two clinical trials registration platforms were searched from inception to May 2021. Randomized clinical trials (RCTs) comparing needle-based acupuncture with pharmacotherapy, and other non-pharmacotherapy or invalid group were included. Two independent reviewers identified eligible studies. Two reviewers independently abstracted and recorded data into a pre-made form. A Bayesian network meta-analysis (NMA) was conducted to assess and compare different techniques using RStudio 3.6.0. The primary outcome was the change in scores of scales measuring depressive symptoms. The secondary outcomes were changes in serotonin levels and in quality of life. Results: Fifty-nine RCTs were included. The results of this NMA showed that compared with western medicine (WM), acupuncture alone or with repetitive transcranial magnetic stimulation (RTMS), Traditional Chinese medicine (TCM) alone or with WM, were superior for alleviating depression symptoms. Compared to Usual Care, acupuncture alone or plus other therapies could significantly decrease scores of the Hamilton Depression Rating scale. However, there was no significant difference found among acupuncture, WM, TCM with AC plus any of other treatment.Conclusions: The results of this study indicate that acupuncture alone or combined with other therapies appear to be effective in improving depression symptoms of stroke survivors. Moreover, in comparison with WM, acupuncture alone or plus RTMS, TCM, TCM with WM, or WM, were more effective in improving depression symptoms. Also, acupuncture with RTMS seems to be the most effective with the highest probability.

A systematic review and network meta-analysis of FDA approved treatment options in men with nonmetastatic, castration-resistant prostate cancer (M0CRPC).

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 335-335
Author(s):  
Irbaz Bin Riaz ◽  
Noureen Asghar ◽  
Daenielle K. Lang ◽  
Yuan Yao ◽  
Anum Riaz ◽  
...  
Keyword(s):  
Adverse Events ◽  
Meta Analysis ◽  
Treatment Options ◽  
Cost Effective ◽  
Cochrane Library ◽  
Castration Resistant Prostate Cancer ◽  
Efficacy Analysis ◽  
Artery Disease ◽  
Grade 3 ◽  
Indirect Comparisons

335 Background: Network meta-analysis can provide useful evidence for relative efficacy and toxicity of different treatment options in absence of head-to-head trials. Previously, we reported no difference in efficacy between Apalutamide (APA) and Enzalutamide (ENZA). In this analysis, we provide updated indirect comparisons of all FDA approved agents (APA,ENZA, Darolutamide(DARO) for the treatment of M0CRPC with rapid PSA doubling time. Methods: MEDLINE, EMBASE and Cochrane Library were searched to identify relevant clinical trials. Hazard ratios (HR) and 95% confidence interval (CI) for Metastasis Free Survival (MFS), Overall Survival (OS) and data on grade 3 or higher AEs were abstracted. Bayesian network meta-analysis was conducted using WinBUGS 1.4.3 software (MRC Biostatistics Unit, Cambridge, UK) to perform an indirect comparisons. Risk for bias was assessed using the Cochrane Collaboration’s tool. Results: Three RCTs (SPARTAN, PROSPER and ARAMIS) compared APA, ENZA and DARO respectively in combination with ADT to ADT alone. A total of 4117 patients were included in efficacy analysis (2694 received novel hormonal agents and 1423 received ADT and placebo). There were no statistically significant differences in MFS (HR 0.97, 95% CrI 0.74 - 1.30) between APA and ENZA; however, both APA 0.69 (95% CI 0.52 -0.92) and ENZA 0.71 (95% CrI 0.53, 0.92) significantly improved MFS as compared to DARO. There were no statistically significant differences in OS between these drugs. DARO had fewer grade 3 or higher adverse events of fatigue (HR 0.09, 95% CrI 0.01 – 0.51) compared to ENZA. However other common adverse events such as hypertension, falls, coronary artery disease/myocardial infarction and diarrhea were not significantly different between treatment groups. There was low risk of bias amongst included studies. Conclusions: APNA and ENZA provide significant improved in MFS as compared to DARO in patients with M0CRPC. The drugs have similar toxicity profile except that DARO was associated with lower incidence of fatigue compared to ENZA. Cost effective analysis of these drugs will be reported separately.

Does glutamine supplementation have favorable effects on glucose control and insulin sensitivity?

2019 ◽  
Vol 50 (1) ◽  
pp. 197-215 ◽  
Author(s):  
Hamed Kord-Varkaneh ◽  
Ammar Salehi-Sahlabadi ◽  
Seyed Mohammad Mousavi ◽  
Somaye Fatahi ◽  
Ehsan Ghaedi ◽  
...  
Keyword(s):  
Randomized Clinical Trials ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Glutamine Supplementation ◽  
Cochrane Library ◽  
Model Assessment ◽  
Content Type ◽  
Insulin Levels ◽  
Polynomial Modeling ◽  
The Impact

Purpose The authors performed a systematic review and meta-analysis of all published randomized controlled trials with the aim to determine and quantify the anti-hyperglycemic effects of glutamine (Gln) in acute and chronic clinical settings. Design/methodology/approach The authors conducted a comprehensive search of all randomized clinical trials performed up to December 2018, to identify those investigating the impact of Gln supplementation on fasting blood sugar (FBS), insulin levels and homeostatic model assessment-insulin resistance (HOMA-IR) via ISI Web of Science, Cochrane library PubMed and SCOPUS databases. A meta-analysis of eligible studies was conducted using random effects model to estimate the pooled effect size. Fractional polynomial modeling was used to explore the dose–response relationships between Gln supplementation and diabetic indices. Findings The results of the present meta-analysis suggest that of Gln supplementation had a significant effect on FBS (weighted mean difference (WMD): –2.868 mg/dl, 95 per cent CI: –5.467, –0.269, p = 0.031). However, the authors failed to observe that Gln supplementation affected insulin levels (WMD: 1.06 units, 95 per cent CI: –1.13, 3.26, p = 0.34) and HOMA-IR (WMD: 0.001 units, 95 per cent CI: –2.031, 2.029, p = 0.999). Subgroup analyses showed that the highest decrease in FBS levels was observed when the duration of intervention was less than two weeks (WMD: –4.064 mg/dl, 95 per cent CI: –7.428, –0.700, p = 0.01) and when Gln was applied via infusion (WMD: –5.334 mg/dl, 95 per cent CI: –10.48, 0.17, p = 0.04). Originality/value The results from this meta-analysis show that Gln supplementation did not have a significant effect on insulin levels and HOMA-IR. However, it did significantly reduce the levels of FBS, obtaining a higher effect when the duration of the intervention period was less than two weeks.

scholarly journals The Efficacy and Safety of Anti-bodies Targeting PD-1 for Treatment in Advanced Esophageal Cancer: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Yao Lu ◽  
Lulu Guan ◽  
Mengli Xu ◽  
Feng Wang
Keyword(s):  
Adverse Effect ◽  
Esophageal Cancer ◽  
Meta Analysis ◽  
Objective Response ◽  
Cochrane Library ◽  
Efficacy And Safety ◽  
Advanced Esophageal Cancer ◽  
Treatment Benefit ◽  
Related Adverse Effect ◽  
Grade 3

Abstract Background: A novel therapy based on programed death 1 (PD-1) inhibitors has been proved to be effective in advanced esophageal cancer. This article is a meta-analysis aiming to compare the efficacy and safety of anti-PD-1 therapy with chemotherapy in esophageal cancer.Patients and methods: Data were collected from eligible studies searched from PubMed, Web of Science, Cochrane Library and Embase. Pooled hazard ratio (HR) for overall survival (OS), progression-free survival (PFS) and objective response rate (ORR) was estimated to assess the efficacy of PD-1 inhibitors versus chemotherapy. The subgroup analysis were also performed to evaluate the OS benefits. The OR for occurrence of treatment-related adverse effect was calculated to assess the safety of anti-PD-1 therapy.Results: A total of 4 studies were analyzed. Compared with patients with chemotherapy, patients with anti-PD-1 therapy had a significant improvement in OS (HR=0.79, 95% CI: 0.71-0.88, P<0.001), but no significant relationship was observed in PFS (HR=0.96, 95% CI: 0.76-1.20, P=0.69) and ORR (OR=1.92, 95% CI: 0.98-3.72, P=0.06). A similar result was observed in esophageal squamous cell carcinoma (ESCC). The significant predictor for treatment benefit with combination therapy versus chemotherapy alone were histology (P=0.009). The incidence of grade 3 to 5 treatment-related adverse effect in anti-PD-1 therapy was distinctly lower than that in chemotherapy, but there is no statistical difference in all treatment-related adverse effect.Conclusion: Anti-PD-1 therapy significantly prolonged the OS, simultaneously lowered grade 3 to 5 treatment-related adverse effect versus chemotherapy.

Meta Analysis of Grade 3 and/or 4 Toxicities in Follicular (FL) and Mantle Cell (MCL) Non-Hodgkin Lymphoma (NHL) Patients Receiving Maintenance Rituximab (MR): Impact of Schedule, Histology, and Induction Regimen

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3654-3654
Author(s):  
Chadi Nabhan ◽  
Dana Villines ◽  
Brian C-H Chiu ◽  
Nicholas J. Ollberding ◽  
Tina V. Valdez ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Research Funding ◽  
Meta Analysis ◽  
Random Effect ◽  
Cochrane Library ◽  
Induction Phase ◽  
Low Grade ◽  
Front Line ◽  
Grade 3 ◽  
The Impact

Abstract Abstract 3654 Background: MR has improved the outcome and progression-free survival (PFS) of patients (pts) with FL and MCL. However, maintenance schedules have been empirically designed with no consensus on the optimal regimen. While toxicities are usually predictable, the impact of MR schedule on toxicities has not been previously reported and could influence selection of maintenance regimens. We analyzed grade 3 and/or 4 adverse events (AE) in FL and MCL pts enrolled in prospective MR trials in order to compare AEs by MR schedule, histology, and setting (front-line and relapsed). Methods: A systematic search of the Medline (Pub-Med, Google Scholar, Cochrane Library) electronic database was performed to identify prospective clinical trials employing MR in FL and MCL. The following search terms were used: “MR, maintenance immunotherapy, maintenance therapy, low-grade lymphoma, NHL, MCL, and FL”. Abstracts and studies using MR after autologous stem cell transplantation or radioimmunotherapy were excluded. The number of AE reported was considered as the unit of analysis. Data for overall Grade 3 and/or Grade 4 toxicity (AE reported at any phase of treatment) were further categorized as an AE occurring during the induction phase or the maintenance phase. The incidence, severity, and type of toxicity were analyzed by type of induction (R vs. R+chemotherapy), histology (FL, MCL and FL plus other low-grade histologies), setting (front-line vs. relapsed), and MR schedule (one dose every 2 months vs. one dose every 3 months vs. 4 weekly doses every 6 months; all given for 2 years) and analysis was performed using t-tests or one-way ANOVA weighted means by either the total sample or the MR phase sample. Means were calculated using both fixed-effect and random-effect models Results: Thirteen clinical trials met criteria, including six trials which were randomized controlled in the MR phase. Of the total 3,100 pts, 1,263 received MR. The mean percentage of Grade 3/4 toxicities during any phase of treatment was 26% (95% CI = 0.12–51.88) but in the MR phase, it was only 12.88% (95% CI = 6.50–19.26). The overall mean number of grade 3/4 toxicities during any phase of treatment was 173.85 (95% CI = 167.76–179.95) and it was 60.5 (95% CI 58–63) in the MR phase. Toxicities were significantly different between induction therapy regimens, front-line and the relapsed settings and histologies (all P < 0.001). Pts receiving MR every 2 months encountered more grade 3 and 4 toxicities (mean percentage = 33%, mean = 97.46, 95% CI = 94.15–100.77) compared to 3 months (mean percentage = 21%, mean = 29.24, 95% CI = 27.92 –30.57) and 6 months (mean percentage = 13%, mean = 11.62, 95% CI = 10.70–12.54) schedules (P < 0.001). Pts receiving R+ chemo induction had more AEs compared to those receiving R induction [(mean=73.9 (95% CI 70.8–77.0) vs. 7.5 (95% CI 6.4–8.5), P<0.001]. Pts receiving MR in front-line had more AEs compared to those receiving MR in relapsed disease [mean= 73.1 (95% CI 69.9–76.6) vs. 43.3 (95% CI 41.3–45.3), P<0.001]. Pts with FL had more AEs compared to those with MCL [mean=72.9 (95% CI 69.8–75.9) vs. 15.3 (95% CI 13.2–17.3), P<0.001] Neutropenia and infections were the most common reported individual toxicities. Conclusions: Approximately 13% of patients receiving MR experience grade 3 and/or 4 toxicities, mainly neutropenia and infections. MR given every 6 months appears to cause fewer toxicities. Importantly, this meta-analysis did not compare relative efficacy amongst the three most commonly used MR schedules, but may be helpful in advising patients of relative risks amongst the three schedules. Disclosures: Nabhan: Genentech: Research Funding, Speakers Bureau. Ghielmini:Roche: Honoraria, Research Funding. Smith:Genentech/Roche: Data Safety Monitoring Board and advisory Board attendance Other.

scholarly journals Toxicities of chemoradiotherapy and radiotherapy in nasopharyngeal carcinoma: an updated meta-analysis

2019 ◽  
Vol 47 (7) ◽  
pp. 2832-2847 ◽  
Author(s):  
Chun Wang ◽  
Fei Wang ◽  
Xin Min ◽  
Qinfang Zhang ◽  
Li-juan Shen ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Late Toxicity ◽  
Nausea And Vomiting ◽  
Cochrane Library ◽  
Random Effects Models ◽  
Acute Nausea ◽  
Radiotherapy Alone ◽  
Grade 3

Objective We investigated the risk of acute and late toxicities of concurrent chemoradiotherapy (CCRT) and radiotherapy alone in patients with nasopharynx carcinoma (NPC). Methods In this meta-analysis, we searched the PubMed, Embase, Cochrane Library, and Web of Science databases for eligible randomized clinical trials (RCTs). In addition to the incidence of specific toxicities, risk ratios (RRs) or odd ratios (ORs) and 95% confidence intervals (CIs) were obtained using fixed-effect or random-effects models. Results In total, 11 RCTs involving 2801 patients with NPC were included in this analysis. For grade ≥3 adverse events, patients who received CCRT treatment had a higher proportion of acute mucositis (39.9% vs. 30.5%, RR=1.30, 95%CI, 1.16–1.46) acute nausea and vomiting (RR=6.26, 95% CI: 2.01–19.45), and neutropenia (RR=30.86, 95% CI: 7.36 to 129.35). For late severe toxicities, CCRT treatment was significantly associated with higher incidence of hearing loss (116.56% vs. 411.43%, RR=1.461, 95%CI, 1.043–21.095). The incidence of acute nausea and vomiting was more frequent in patients receiving CCRT. Conclusion Compared with radiotherapy alone, CCRT increases the risk of severe acute toxicities (mucositis, nausea/vomiting, and neutropenia) and severe late toxicity (hearing loss) in patients with NPC. However, larger studies are needed to confirm this finding.

scholarly journals The efficacy and safety of combined immune checkpoint inhibitors (nivolumab plus ipilimumab): a systematic review and meta-analysis

2020 ◽  
Author(s):  
Lihu Gu ◽  
Shengnan Li ◽  
Nannan Du ◽  
Qigu Yao ◽  
Xiaojun Fu ◽  
...  
Keyword(s):  
Adverse Events ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Meta Analysis ◽  
Objective Response ◽  
Cochrane Library ◽  
Effect Estimate ◽  
Grade 3 ◽  
Combined Immunotherapy

Abstract Background: Currently, nivolumab and ipilimumab are the most widely used immune checkpoint inhibitors. We performed a meta-analysis to evaluate the efficacy and treatment-related adverse events (TRAEs) of nivolumab-ipilimumab combination therapy in cancer treatment. Methods: We examined data from PubMed, Web of science, EBSCO and Cochrane library. Eleven articles fulfilled our criteria, which we divided into 3 groups; nivolumab and ipilimumab versus ipilimumab, nivolumab and ipilimumab versus ipilimumab and nivolumab 1 mg/kg plus ipilimumab 3 mg/kg (N1I3) versus nivolumab 3 mg/kg plus ipilimumab 1 mg/kg (N3I1). We measured the complete response (CR), partial response (PR), objective response rate (ORR) and TRAEs in any grade and grade 3 or higher. Results: Compared with ipilimumab alone, the combined immunotherapy had better CR (RR: 4.89, p <0.001), PR (RR: 2.75, p <0.001), and ORR (RR: 3.31, p <0.001). The overall effect estimate favored the combined immunotherapy group in terms of the ORR (RR: 1.40, p <0.001) and PR (RR: 1.50, p <0.001) than nivolumab alone. Finally, N1I3 showed better PR (RR: 1.35, p =0.006) and ORR (RR: 1.21, p =0.03) than N3I1. The incidence of any TRAEs was similar between the both groups (RR: 1.05, p =0.06). However, the incidence of serious adverse events (grade 3 or higher) were lower in group N3I1 than group N1I3 (RR: 1.51, p <0.001). Conclusion: This meta-analysis showed that the curative effect of nivolumab plus ipilimumab was better than that of ipilimumab or nivolumab monotherapy. In the combination group, N1I3 combination was more effective than N3I1. Although the side effects were slightly increased in group N1I3, the overall safety was acceptable.

Laser Influence on Dental Sensitivity Compared to Other Light Sources Used During In-office Dental Bleaching: Systematic Review and Meta-analysis

2020 ◽  
Vol 45 (6) ◽  
pp. 589-597
Author(s):  
BGS Casado ◽  
EP Pellizzer ◽  
JR Souto Maior ◽  
CAA Lemos ◽  
BCE Vasconcelos ◽  
...  
Keyword(s):  
Randomized Clinical Trials ◽  
Color Change ◽  
Meta Analysis ◽  
Present Review ◽  
Cochrane Library ◽  
Light Sources ◽  
Eligibility Criteria ◽  
Tooth Color ◽  
Significant Difference ◽  
Meta Analyses

Clinical Relevance The use of laser light during bleaching will not reduce the incidence or severity of sensitivity and will not increase the degree of color change compared with nonlaser light sources. SUMMARY Objective: To evaluate whether the use of laser during in-office bleaching promotes a reduction in dental sensitivity after bleaching compared with other light sources. Methods: The present review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and is registered with PROSPERO (CDR42018096591). Searches were conducted in the PubMed/Medline, Web of Science, and Cochrane Library databases for relevant articles published up to August 2018. Only randomized clinical trials among adults that compared the use of laser during in-office whitening and other light sources were considered eligible. Results: After analysis of the texts retrieved during the database search, six articles met the eligibility criteria and were selected for the present review. For the outcome dental sensitivity, no significant difference was found favoring any type of light either for intensity (mean difference [MD]: −1.60; confidence interval [CI]: −3.42 to 0.22; p=0.09) or incidence (MD: 1.00; CI: 0.755 to 1.33; p=1.00). Regarding change in tooth color, no significant differences were found between the use of the laser and other light sources (MD: −2.22; CI: −6.36 to 1.93; p=0.29). Conclusions: Within the limitations of the present study, laser exerts no influence on tooth sensitivity compared with other light sources when used during in-office bleaching. The included studies demonstrated that laser use during in-office bleaching may have no influence on tooth color change.

Sign in / Sign up

Export Citation Format

Share Document