Evidence map›Paper›PMID 39086088›Full record

SynthesisThoracic cancer2024

Efficacy of first-line immune checkpoint inhibitor and anti-angiogenic agent combination therapy for Kirsten rat sarcoma viral antigen-mutant advanced non-small-cell lung cancer: a systematic review and network meta-analysis.

Akinari Tsukada, Chie Morita, Yosuke Shimizu, Yukari Uemura, Go Naka, Jin Takasaki, Hiroshi Nokihara, Shinyu Izumi, Masayuki Hojo

Abstract readSystematic ReviewNetwork Meta-Analysis
In one paragraph

Synthesis in Thoracic cancer, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Akinari TsukadaDepartment of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan.ORCID 0000-0001-8582-1964
Chie MoritaDepartment of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan.
Yosuke ShimizuCenter for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan.
Yukari UemuraCenter for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan.
Go NakaDepartment of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan.
Jin TakasakiDepartment of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan.
Hiroshi NokiharaDepartment of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan.ORCID 0000-0002-1219-6966
Shinyu IzumiDepartment of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan.
Masayuki HojoDepartment of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundRecent advancements in advanced non-small-cell lung cancer (NSCLC) treatment have significantly improved primary therapy outcomes owing to the emergence of various molecular targeted therapies and immune checkpoint inhibitors (ICIs). However, for Kirsten rat sarcoma viral antigen (KRAS) mutations, molecular targeted drugs, such as sotorasib, are not applicable as first-line treatments, and the optimal primary treatment remains unclear. Therefore, we aimed to investigate the efficacy of ICI combination therapy as first-line treatment for KRAS-mutant NSCLC.

methodsWe conducted a systematic search for phase 3 randomized controlled trials (RCTs) that presented data on KRAS mutation status in advanced NSCLC. The primary endpoints were progression-free survival (PFS) and overall survival (OS). A random-effects network meta-analysis was conducted to perform direct and indirect comparisons among treatment groups.

resultsSix RCTs were eligible for inclusion. In the network meta-analysis for KRAS-mutant NSCLC, Chemo + bevacizumab (Bev) + ICI was associated with improved PFS (hazard ratio [HR] 0.38, 95% confidence interval [CI] 0.22-0.64), followed by Chemo + ICI + ICI (HR 0.66, 95% CI 0.47-0.93) and Chemo + ICI (HR 0.67, 95% CI 0.49-0.91). The most beneficial effect on OS was observed with Chemo + Bev + ICI (HR 0.50, 95% CI 0.34-0.73), followed by Chemo + ICI + ICI (HR 0.64, 95% CI 0.48-0.87) and Chemo + ICI (HR 0.72, 95% CI 0.56-0.92). Regarding OS in wild-type KRAS, ICI + ICI (HR 0.73, 95% CI 0.50-1.07) produced the most favorable effects, followed by Chemo + ICI (HR 0.79, 95% CI 0.63-0.99).

conclusionThe efficacy of Chemo + Bev + ICI is potentially high for improving PFS and OS in KRAS-mutant NSCLC. In advanced NSCLC, the presence or absence of KRAS mutations may need to be considered when administering first-line treatment.

Indexed as

Carcinoma, Non-Small-Cell LungImmune Checkpoint InhibitorsLung NeoplasmsAngiogenesis InhibitorsAntineoplastic Combined Chemotherapy ProtocolsHumansMutationProto-Oncogene Proteins p21(ras)Angiogenesis InhibitorsImmune Checkpoint InhibitorsKRAS protein, humanProto-Oncogene Proteins p21(ras)immune checkpoint inhibitorsKRASnetwork meta‐analysisnon‐small‐cell lung cancer

Identifiers

PMID39086088
PMCPMC11367661

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.