1.
Comparison of First-Line Treatments for Patients With Extensive-Stage Small Cell Lung Cancer: A Systematic Review and Network Meta-analysis.
Zhou, T, Zhang, Z, Luo, F, Zhao, Y, Hou, X, Liu, T, Wang, K, Zhao, H, Huang, Y, Zhang, L
JAMA network open. 2020;(10):e2015748
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Abstract
IMPORTANCE Combinations of chemotherapy with immunotherapy or bevacizumab in first-line treatments of extensive-stage small cell lung cancer (ES-SCLC) have been evaluated in various clinical trials. However, it remains unclear what the optimal combination regimen is. OBJECTIVE To clarify which first-line combination regimen is associated with the best tumor response among patients with ES-SCLC. DATA SOURCES Electronic databases (PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science) were systematically searched to extract eligible literature from database inception to December 2019. STUDY SELECTION Head-to-head randomized clinical trials on first-line treatments for patients with ES-SCLC were included with outcomes and toxic effects reported, including objective response rate (ORR, involving complete response and partial response), disease control rate (DCR, involving complete response, partial response, and stable disease), progression-free survival (PFS), overall survival (OS), and treatment related adverse events (TRAEs) of grades 3 to 5. Of 199 eligible articles, 14 were included. DATA EXTRACTION AND SYNTHESIS Data were independently extracted and collected by 2 reviewers based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Data were pooled using a random-effects model. MAIN OUTCOMES AND MEASURES Main outcomes were OS, PFS, DCR, ORR, and TRAEs of grades 3 to 5. RESULTS A total of 3 phase 2 and 11 phase 3 randomized clinical trials involving 4838 patients were included. Programmed cell death ligand 1 (PD-L1) inhibitor (durvalumab and atezolizumab) plus etoposide-based chemotherapy, compared with etoposide-based chemotherapy alone, showed the most favorable OS (hazard ratio, 1.40; 95% CI, 1.09-1.80) and the best DCR (odds ratio [OR], 0.42; 95% CI, 0.21-0.81). Bevacizumab plus etoposide-based chemotherapy provided the best PFS compared with etoposide-based chemotherapy alone (hazard ratio, 1.54; 95% CI, 1.09-2.27), although this was not translated into OS benefit. The addition of PD-L1 inhibitors to etoposide-platinum chemotherapy caused no more toxic effects in general (compared with etoposide-based chemotherapy alone: OR, 1.14; 95% CI, 0.36-2.31), while bevacizumab plus etoposide-platinum regimen induced the most TRAEs grades 3 to 5 among all first-line treatments (eg, compared with irinotecan-platinum regimen: OR, 4.24; 95% CI, 1.26-14.57). Based on the surface under the cumulative ranking curve value, PD-L1 inhibitor plus etoposide-platinum had the highest probability of being ranked first for OS (0.87) and DCR (0.97). CONCLUSIONS AND RELEVANCE The findings of this systematic review and network meta-analysis suggest that the combination of a PD-L1 inhibitor (durvalumab and atezolizumab) and etoposide-based chemotherapy may be an optimal first-line treatment option for patients with ES-SCLC patients.
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Energy spectrum computed tomography improves the differentiation between benign and malignant solitary pulmonary nodules.
Zhao, J, Chai, Y, Zhou, J, Zhang, Z, Wang, Z
Clinical and investigative medicine. Medecine clinique et experimentale. 2019;(3):E40-E46
Abstract
PURPOSE To evaluate the diagnostic efficiency of computed tomography (CT) values at the 40~140 keV monochromatic level for the differential diagnosis of solitary pulmonary nodules (SPNs). METHODS Energy spectrum CT data of 44 patients with SPNs were analyzed retrospectively; 24 patients with malignant SPNs served as the malignant group and 20 patients with benign SPNs served as the benign group. The basic material concentration and the enhancement degree differences in double-phase enhanced scans were compared between the two groups. The sensitivity and specificity were calculated to determine diagnosis, and were compared with the pathology results. RESULTS The CT values at the 40~90 keV monochromatic level and the iodine concentrations of malignant group were higher than those of benign group in the arterial phase (all P < 0.05). The enhancement degree of the malignant group was higher than that for the benign group in the arterial phase (36.36 ± 33.18 HU vs 16.93 ± 24.17 HU t = 2.243, P = 0.030); however, the enhancement degrees of the two groups were similar in the venous phase (21.99 ± 15.87 HU vs 17.62 ± 24.15 HU t = 0.694, P = 0.493). The area under the curve of the enhancement degree in the arterial phase was 0.792. CONCLUSIONS Monochromatic imaging and base material concentration of energy spectrum CT can help differentiate between benign and malignant SPNs.
3.
[A meta analysis of radiosensitivity on non-small cell lung cancer by metronidazole amino acidum natrium].
Ren, W, Li, Z, Mi, D, Yang, K, Tian, J, Zhang, Z
Zhongguo fei ai za zhi = Chinese journal of lung cancer. 2012;(6):340-7
Abstract
BACKGROUND AND OBJECTIVE The efficacy and safety of radiosensitivity on non-small cell lung cancer (NSCLC) using metronidazole amino acidum natrium (CMNa) are yet to be proven. This study evaluates the efficacy and safety of radiosensitivity on NSCLC by CMNa to provide references for further clinical practice and research. METHODS Relevant randomized controlled trials (RCTs) were obtained from the Cochrane library, Pubmed, EMbase, CBM, CNKI, VIP, and Wan Fang databases. Dates were searched through other means. RCTs of radiosensitivity on NSCLC by CMNa were included. The data included in the study were evaluated and analyzed using the Cochrane Collaboration's RevMan 5.1 software. RESULTS A total of 21 RCTs were included. The results of the meta-analyses showed that the total effective rate of the test group that received CMNa plus radiotherapy was higher than that of the control group that received radiotherapy alone (OR=3.29, 95%CI: 2.47-4.39, P<0.000,01) or radiotherapy plus placebo (OR=3.65, 95%CI: 2.25-5.92, P<0.000,01), respectively. No significant differences were found in the quality of life between one and two-year survival rates (P>0.05). No significant differences were found among radiation pneumonitis, radiation esophagitis, hematological toxicity, and cardiotoxicity (P>0.05). CONCLUSIONS CMNa plus radiotherapy elicit beneficial effects in the treatment of NSCLC and produce fewer adverse effects. Therefore, this technique can be recommended and applied in clinics.