Brain Metastases Status and Immunotherapy Efficacy in Advanced Lung Cancer: A Systematic Review and Meta-Analysis
BackgroundBrain metastases (BMs) indicate poor outcomes and are commonly excluded in immunotherapy clinical trials in advanced lung cancer; moreover, the effect of BM status on immunotherapy efficacy is inconsistent and inconclusive. Therefore, we conducted a meta-analysis to assess the influence of...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2021-07-01
|
| Series: | Frontiers in Immunology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2021.669398/full |
| _version_ | 1818654849179320320 |
|---|---|
| author | Hao Hu Zhi-Yong Xu Qian Zhu Xi Liu Si-Cong Jiang Ji-Hua Zheng |
| author_facet | Hao Hu Zhi-Yong Xu Qian Zhu Xi Liu Si-Cong Jiang Ji-Hua Zheng |
| author_sort | Hao Hu |
| collection | DOAJ |
| description | BackgroundBrain metastases (BMs) indicate poor outcomes and are commonly excluded in immunotherapy clinical trials in advanced lung cancer; moreover, the effect of BM status on immunotherapy efficacy is inconsistent and inconclusive. Therefore, we conducted a meta-analysis to assess the influence of BM status on immunotherapy efficacy in advanced lung cancer.MethodsElectronic databases and all major conference proceedings were searched without language restrictions according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. We extracted randomized clinical trials on lung cancer immunotherapy that had available overall survival (OS) and/or progression-free survival (PFS) data based on the BM status. All analyses were performed using random effects models.ResultsFourteen randomized clinical trials with 9,089 patients were identified. Immunotherapy conferred a survival advantage to BM patients [OS-hazard ratio (HR), 0.72; 95% confidence interval (CI), 0.58–0.90; P = 0.004; and PFS-HR, 0.68; 95% CI, 0.52–0.87, P = 0.003]. Non-BM patients could also derive a survival benefit from immunotherapy (OS-HR, 0.76; 95% CI, 0.71–0.80; P <0.001; and PFS-HR, 0.68; 95% CI, 0.56–0.82, P <0.001). The pooled ratios of OS-HRs and PFS-HRs reported in BM patients versus non-BM patients were 0.96 (95% CI, 0.78–1.18; P = 0.72) and 0.97 (95% CI, 0.79–1.20; P = 0.78), respectively, indicating no statistically significant difference between them. Subsequent sensitivity analyses did not alter the results. Subgroup analyses according to tumor type, line of therapy, immunotherapy type, study design, and representation of BM patients reconfirmed these findings.ConclusionWe demonstrated that BM status did not significantly influence the immunotherapy efficacy in lung cancer, suggesting that both BM and non-BM patients could obtain comparable benefits.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier (CRD42020207446). |
| first_indexed | 2024-12-17T03:00:20Z |
| format | Article |
| id | doaj.art-40daddb2cf0e41729f87a3cb75d1269c |
| institution | Directory Open Access Journal |
| issn | 1664-3224 |
| language | English |
| last_indexed | 2024-12-17T03:00:20Z |
| publishDate | 2021-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Immunology |
| spelling | doaj.art-40daddb2cf0e41729f87a3cb75d1269c2022-12-21T22:06:07ZengFrontiers Media S.A.Frontiers in Immunology1664-32242021-07-011210.3389/fimmu.2021.669398669398Brain Metastases Status and Immunotherapy Efficacy in Advanced Lung Cancer: A Systematic Review and Meta-AnalysisHao Hu0Zhi-Yong Xu1Qian Zhu2Xi Liu3Si-Cong Jiang4Ji-Hua Zheng5Department of Radiation Therapy, General Hospital of Southern Theater Command, Guangzhou, ChinaThe Second Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, ChinaDepartment of Intensive Care Unit, Sun Yat-sen University Cancer Center, Guangzhou, ChinaDepartment of Thoracic Surgery, Jiangxi Cancer Hospital of Nanchang University, Nanchang, ChinaDepartment of Thoracic Surgery, Jiangxi Cancer Hospital of Nanchang University, Nanchang, ChinaDepartment of Radiation Therapy, General Hospital of Southern Theater Command, Guangzhou, ChinaBackgroundBrain metastases (BMs) indicate poor outcomes and are commonly excluded in immunotherapy clinical trials in advanced lung cancer; moreover, the effect of BM status on immunotherapy efficacy is inconsistent and inconclusive. Therefore, we conducted a meta-analysis to assess the influence of BM status on immunotherapy efficacy in advanced lung cancer.MethodsElectronic databases and all major conference proceedings were searched without language restrictions according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. We extracted randomized clinical trials on lung cancer immunotherapy that had available overall survival (OS) and/or progression-free survival (PFS) data based on the BM status. All analyses were performed using random effects models.ResultsFourteen randomized clinical trials with 9,089 patients were identified. Immunotherapy conferred a survival advantage to BM patients [OS-hazard ratio (HR), 0.72; 95% confidence interval (CI), 0.58–0.90; P = 0.004; and PFS-HR, 0.68; 95% CI, 0.52–0.87, P = 0.003]. Non-BM patients could also derive a survival benefit from immunotherapy (OS-HR, 0.76; 95% CI, 0.71–0.80; P <0.001; and PFS-HR, 0.68; 95% CI, 0.56–0.82, P <0.001). The pooled ratios of OS-HRs and PFS-HRs reported in BM patients versus non-BM patients were 0.96 (95% CI, 0.78–1.18; P = 0.72) and 0.97 (95% CI, 0.79–1.20; P = 0.78), respectively, indicating no statistically significant difference between them. Subsequent sensitivity analyses did not alter the results. Subgroup analyses according to tumor type, line of therapy, immunotherapy type, study design, and representation of BM patients reconfirmed these findings.ConclusionWe demonstrated that BM status did not significantly influence the immunotherapy efficacy in lung cancer, suggesting that both BM and non-BM patients could obtain comparable benefits.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier (CRD42020207446).https://www.frontiersin.org/articles/10.3389/fimmu.2021.669398/fullbrain metastasesefficacyimmunotherapylung cancerprogrammed cell death ligand 1 |
| spellingShingle | Hao Hu Zhi-Yong Xu Qian Zhu Xi Liu Si-Cong Jiang Ji-Hua Zheng Brain Metastases Status and Immunotherapy Efficacy in Advanced Lung Cancer: A Systematic Review and Meta-Analysis Frontiers in Immunology brain metastases efficacy immunotherapy lung cancer programmed cell death ligand 1 |
| title | Brain Metastases Status and Immunotherapy Efficacy in Advanced Lung Cancer: A Systematic Review and Meta-Analysis |
| title_full | Brain Metastases Status and Immunotherapy Efficacy in Advanced Lung Cancer: A Systematic Review and Meta-Analysis |
| title_fullStr | Brain Metastases Status and Immunotherapy Efficacy in Advanced Lung Cancer: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Brain Metastases Status and Immunotherapy Efficacy in Advanced Lung Cancer: A Systematic Review and Meta-Analysis |
| title_short | Brain Metastases Status and Immunotherapy Efficacy in Advanced Lung Cancer: A Systematic Review and Meta-Analysis |
| title_sort | brain metastases status and immunotherapy efficacy in advanced lung cancer a systematic review and meta analysis |
| topic | brain metastases efficacy immunotherapy lung cancer programmed cell death ligand 1 |
| url | https://www.frontiersin.org/articles/10.3389/fimmu.2021.669398/full |
| work_keys_str_mv | AT haohu brainmetastasesstatusandimmunotherapyefficacyinadvancedlungcancerasystematicreviewandmetaanalysis AT zhiyongxu brainmetastasesstatusandimmunotherapyefficacyinadvancedlungcancerasystematicreviewandmetaanalysis AT qianzhu brainmetastasesstatusandimmunotherapyefficacyinadvancedlungcancerasystematicreviewandmetaanalysis AT xiliu brainmetastasesstatusandimmunotherapyefficacyinadvancedlungcancerasystematicreviewandmetaanalysis AT sicongjiang brainmetastasesstatusandimmunotherapyefficacyinadvancedlungcancerasystematicreviewandmetaanalysis AT jihuazheng brainmetastasesstatusandimmunotherapyefficacyinadvancedlungcancerasystematicreviewandmetaanalysis |