ANtiangiogenic Second-line Lung cancer Meta-Analysis on individual patient data in non-small cell lung cancer: ANSELMA.
Antiaangiogenics
Individual patient data
Meta-analysis
Metastatic
Non-small cell lung cancer
Randomised clinical trials
Second line
Systematic review
Journal
European journal of cancer (Oxford, England : 1990)
ISSN: 1879-0852
Titre abrégé: Eur J Cancer
Pays: England
ID NLM: 9005373
Informations de publication
Date de publication:
05 2022
05 2022
Historique:
received:
31
01
2022
accepted:
02
02
2022
pubmed:
15
3
2022
medline:
27
4
2022
entrez:
14
3
2022
Statut:
ppublish
Résumé
Now that immunotherapy plus chemotherapy (CT) is one standard option in first-line treatment of advanced non-small cell lung cancer (NSCLC), there exists a medical need to assess the efficacy of second-line treatments (2LT) with antiangiogenics (AA). We performed an individual patient data meta-analysis to validate the efficacy of these combinations as 2LT. Randomised trials of AA plus standard 2LT compared to 2LT alone that ended accrual before 2015 were eligible. Fixed-effect models were used to compute pooled hazard ratios (HRs) for overall survival (OS, main end-point), progression-free survival (PFS) and subgroup analyses. Sixteen trials were available (8,629 patients, 64% adenocarcinoma). AA significantly prolonged OS (HR = 0.93 [95% confidence interval {CI}: 0.89; 0.98], p = 0.005) and PFS (0.80 [0.77; 0.84], p < 0.0001) compared with 2LT alone. Absolute 1-year OS and PFS benefit for AA were +1.8% [-0.4; +4.0] and +3.5% [+1.9; +5.1], respectively. The OS benefit of AA was higher in younger patients (HR = 0.87 [95% CI: 0.76; 1.00], 0.89 [0.81; 0.97], 0.94 [0.87; 1.02] and 1,04 [0.93; 1.17] for patients <50, 50-59, 60-69 and ≥ 70 years old, respectively; trend test: p = 0.02) and in patients who started AA within 9 months after starting the first-line therapy (0.88 [0.82; 0.99]) than in patients who started AA later (0.99 [0.91; 1.08]) (interaction: p = 0.03). Results were similar for PFS. AA increased the risk of hypertension (p < 0.0001), but not the risk of pulmonary thromboembolic events (p = 0.21). In the 2LT of advanced NSCLC, adding AA significantly prolongs OS and PFS, but the benefit is clinically limited, mainly observed in younger patients and after shorter time since the start of first-line therapy.
Sections du résumé
BACKGROUND
Now that immunotherapy plus chemotherapy (CT) is one standard option in first-line treatment of advanced non-small cell lung cancer (NSCLC), there exists a medical need to assess the efficacy of second-line treatments (2LT) with antiangiogenics (AA). We performed an individual patient data meta-analysis to validate the efficacy of these combinations as 2LT.
METHODS
Randomised trials of AA plus standard 2LT compared to 2LT alone that ended accrual before 2015 were eligible. Fixed-effect models were used to compute pooled hazard ratios (HRs) for overall survival (OS, main end-point), progression-free survival (PFS) and subgroup analyses.
RESULTS
Sixteen trials were available (8,629 patients, 64% adenocarcinoma). AA significantly prolonged OS (HR = 0.93 [95% confidence interval {CI}: 0.89; 0.98], p = 0.005) and PFS (0.80 [0.77; 0.84], p < 0.0001) compared with 2LT alone. Absolute 1-year OS and PFS benefit for AA were +1.8% [-0.4; +4.0] and +3.5% [+1.9; +5.1], respectively. The OS benefit of AA was higher in younger patients (HR = 0.87 [95% CI: 0.76; 1.00], 0.89 [0.81; 0.97], 0.94 [0.87; 1.02] and 1,04 [0.93; 1.17] for patients <50, 50-59, 60-69 and ≥ 70 years old, respectively; trend test: p = 0.02) and in patients who started AA within 9 months after starting the first-line therapy (0.88 [0.82; 0.99]) than in patients who started AA later (0.99 [0.91; 1.08]) (interaction: p = 0.03). Results were similar for PFS. AA increased the risk of hypertension (p < 0.0001), but not the risk of pulmonary thromboembolic events (p = 0.21).
CONCLUSIONS
In the 2LT of advanced NSCLC, adding AA significantly prolongs OS and PFS, but the benefit is clinically limited, mainly observed in younger patients and after shorter time since the start of first-line therapy.
Identifiants
pubmed: 35286903
pii: S0959-8049(22)00075-2
doi: 10.1016/j.ejca.2022.02.002
pii:
doi:
Substances chimiques
Angiogenesis Inhibitors
0
Types de publication
Journal Article
Meta-Analysis
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
112-125Investigateurs
B Besse
(B)
B Lacas
(B)
J P Pignon
(JP)
J Remon
(J)
T Berghmans
(T)
S Dahlberg
(S)
E Felip
(E)
Thierry Berghmans
(T)
Benjamin Besse
(B)
Suzanne Dahlberg
(S)
Enriqueta Felip
(E)
Edward Garon
(E)
Harry J M Groen
(HJM)
Nasser Hanna
(N)
Rebecca S Heist
(RS)
Roy Herbst
(R)
John V Heymach
(JV)
Benjamin Lacas
(B)
Alex A Adjei
(AA)
Rebecca Heist
(R)
Sumithra J Mandrekar
(SJ)
Joel W Neal
(JW)
Isamu Okamoto
(I)
Jean-Pierre Pignon
(JP)
Rodryg Ramlau
(R)
Jordi Remon
(J)
Martin Reck
(M)
Giorgio V Scagliotti
(GV)
Johan Vansteenkiste
(J)
Kiyotaka Yoh
(K)
Informations de copyright
Copyright © 2022 Elsevier Ltd. All rights reserved.
Déclaration de conflit d'intérêts
Conflict of interest statement RH, MR, EBG, GVS, RR, NH, JV, KY, HG, JH and RH are authors for some of the trials included in this meta-analysis. Other authors have not reported any conflict of interest related to this study.