Thoracic perfusion of antiangiogenic agents combined with chemotherapy for treating malignant pleural effusion in non-small cell lung cancer: a network meta-analysis

• Published in: BMJ open Vol. 14; no. 12; p. e080703
• Main Authors: Xu, Yan, Cui, Yingying, Jiang, Liming, Yu, Yinan, Si, Wei, Zhu, Xiaohua
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 20.12.2024; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Angiogenesis; Angiogenesis Inhibitors - administration & dosage; Angiogenesis Inhibitors - therapeutic use; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Cancer therapies; Carcinoma, Non-Small-Cell Lung - complications; Carcinoma, Non-Small-Cell Lung - drug therapy; Chemotherapy; Clinical Decision-Making; Dyspnea; Humans; Lung cancer; Lung Neoplasms - complications; Lung Neoplasms - drug therapy; Medical prognosis; Meta-analysis; Oncology; Original Research; Pleural effusion; Pleural Effusion, Malignant - drug therapy; Pleural Effusion, Malignant - etiology; Randomized Controlled Trials as Topic; Respiratory tract tumours; Systematic Review; Tumors; Vascular endothelial growth factor; Respiratory tract tumours; Clinical Decision-Making; Systematic Review
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2023-080703

ObjectivesDifferent intrathoracic perfusion therapeutic regimens are available for non-small cell lung cancer with malignant pleural effusion (MPE). Antiangiogenic agents are often used to control MPE, and the results are satisfactory. Here, we performed a network meta-analysis to reveal optimal combinations of antiangiogenic agents and chemical agents and assess their effectiveness and safety.DesignSystematic review and network meta-analysis.Data sourcesPubMed/Medline, Embase, Cochrane, Web of Science, Wanfang, VIP Database and Chinese National Knowledge Infrastructure were searched from inception to May 2023. Eligible studies were randomised controlled trials that reported on curative effect of MPE.Data extraction and synthesisThe Cochrane Collaboration tool was used to assess risk of bias. The consistency was evaluated by examining the agreement between direct and indirect effects. Network meta-analysis was performed and the ranking probabilities of being at each possible rank for each intervention were estimated. Comparison-adjusted funnel plots were obtained to assess publication bias.ResultsA total of 46 studies were included in the analysis. Among them, we included a total of seven interventions. A total of 3026 patients participated in this analysis. According to the results of the network meta-analysis, some antiangiogenic agents combined with chemotherapy regimens improved objective response rate (ORR) and disease control rate (DCR) and quality of life (QOL). The rank probabilities suggested that in terms of ORR, DCR and QOL, Endostar plus lobaplatin was the first-ranked intervention.ConclusionAdministration of antiangiogenic agents plus chemical agents significantly improved the clinical response and QOL. In addition, Endostar plus lobaplatin was the most effective combination.PROSPERO registration numberCRD42021284786.