Efficacy and safety of targeted therapy combined with anti-angiogenesis treatment in brain metastases of non-small cell lung cancer: a systematic review and meta-analysis
A partir d'une revue systématique de la littérature (6 études, 669 patients), cette méta-analyse évalue l'efficacité, du point de vue du taux de réponse et du taux de contrôle de la maladie, et la toxicité d'une thérapie ciblée en combinaison avec un traitement anti-angiogénique pour prendre en charge les métastases cérébrales chez les patients atteints d'un cancer du poumon non à petites cellules
Purpose: Brain metastases in non-small cell lung cancer (NSCLC) pose significant treatment challenges. This study aims to analyze whether the combination of targeted therapy and antiangiogenic therapy may bring greater clinical benefits.
Methods: We conducted a systematic review and meta-analysis of studies evaluating the efficacy and safety of targeted therapy combined with antiangiogenic therapy in patients with brain metastases from NSCLC. Pooled odds ratios (ORs) and hazard ratios (HRs) were calculated to determine the overall effect of combination therapy on clinical outcomes.
Results: Among the six included studies (n = 669), five studies used EGFR-TKI + Bevacizumab for combination therapy, and one study used EGFR-TKI + Endostar. Combination therapy significantly improved disease control rate (DCR) (OR = 3.98, 95 % CI: 2.56–6.18, p < 0.001) and response rate (RR) (OR = 6.63, 95 % CI: 2.89–15.22, p < 0.001) compared to controls. Progression-free survival (PFS) was markedly prolonged (HR = 0.52, 95 % CI: 0.39–0.69, p < 0.001), and overall survival (OS) improved significantly (HR = 5.75, 95 % CI: 3.22–10.29, p < 0.001). Subgroup analyses confirmed higher rates of hypertension and proteinuria when compared to targeted monotherapy (both p < 0.001). Other common adverse events showed no significant difference.
Conclusions: Targeted therapy combined with anti-angiogenesis treatment significantly enhances clinical outcomes in NSCLC patients with brain metastases, including DCR, RR, PFS, and OS. Nonetheless, this combination increases the risk of adverse events, necessitating careful management
Lung Cancer , résumé 2024