SynthesisCancer medicine2026
The Promise of Chemotherapy-Free Strategies in Advanced Driver-Negative NSCLC: A Systematic Review and Network Meta-Analysis of Antiangiogenic Combination Therapies.
Synthesis in Cancer medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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9 authors.
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Abstract
backgroundAntiangiogenic combination therapy-antiangiogenic agents combined with immune checkpoint inhibitors and/or chemotherapy-has become an important treatment strategy for advanced driver-negative non-small cell lung cancer (NSCLC). We conducted a network meta-analysis to compare efficacy and safety and identify optimal antiangiogenic combinations.
methodsWe searched PubMed, Embase, Web of Science, and Cochrane Library for randomized controlled trials (RCTs) that evaluated antiangiogenic combination therapies. Primary outcomes were progression-free survival (PFS), overall survival (OS), objective response rate (ORR), and incidence of grade ≥ 3 treatment-related adverse events (TRAEs).
resultsNine treatment regimens comprising 5954 patients were included. The network meta-analysis indicated that the chemotherapy-free regimen of sintilimab + anlotinib achieved the greatest progression-free survival (PFS) benefit, compared with chemotherapy (HR = 0.39, 95% CI 0.23-0.67), and the lowest incidence of grade ≥ 3 treatment-related adverse events (TRAEs) (RR = 0.57, 95% CI 0.32-0.95). Recombinant human endostatin (Endostar) + chemotherapy provided the largest overall survival (OS) benefit vs. chemotherapy (HR = 0.46, 95% CI 0.36-0.58). The triplet regimen of atezolizumab, bevacizumab, and chemotherapy yielded the largest improvement in objective response rate (ORR) vs. bevacizumab + chemotherapy (OR = 1.90, 95% CI 1.40-2.60). Across most subgroup analyses, regimens combining immunotherapy, an antiangiogenic agent, and chemotherapy conferred the greatest PFS and OS benefits.
conclusionsThis network meta-analysis demonstrates that antiangiogenic combinations improve outcomes in driver-negative advanced NSCLC. Endostar + chemotherapy offers the greatest OS benefit, atezolizumab-bevacizumab-chemotherapy improves ORR, and sintilimab-anlotinib provides superior PFS with lower toxicity. Treatment should be tailored based on clinical factors, with further validation in multiethnic trials.
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