SynthesisMedicine2026
Efficacy and safety of first-line immune checkpoint inhibitors combinations for extensive-stage small-cell lung cancer: A systematic review and network meta-analysis.
Synthesis in 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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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.
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6 authors.
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Abstract
backgroundCombining immune checkpoint inhibitors (ICIs) with chemotherapy has become a major clinical research focus. Patients with extensive-stage small-cell lung cancer (ES-SCLC) have been treated with different first-line ICI combinations in randomized controlled trials (RCTs), but the optimal combination strategy has not yet been determined. Our aim was to evaluate this strategy through a systematic review and meta-analysis.
methodsArticles published from inception to October 20, 2024 were systematically searched in PubMed, Cochrane CENTRAL, Embase, and MEDLINE. Candidates were RCTs using ICI treatments as first-line treatment for ES-SCLC. According to PRISMA guidelines, 3 independent investigators extracted data. Hazard/odds ratios (HRs/ORs) with their 95% confidence intervals (CIs) and adverse event (AEs) were extracted. ICI combinations were compared for overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and AEs. A random-effects model and Bayesian network meta-analysis were used. PROSPERO: CRD42023388838.
resultsThe meta-analysis included 8 RCTs with 3910 patients. Overall, ICI-chemotherapy provided superior OS (HR, 0.78; 95% CI, 0.72 to 0.86), PFS (HR, 0.73; 95% CI, 0.64 to 0.82), ORR (OR, 1.20; 95% CI, 1.01 to 1.42) and DCR (OR, 2.64; 95% CI, 1.32 to 5.24) compared with chemotherapy alone. A higher risk of any grade irAEs (OR, 3.88; 95% CI, 2.09 to 7.18) and grade ≥ 3 irAEs (OR, 5.54; 95% CI, 2.38 to 12.88) was associated with ICI addition. ICI-chemotherapy combinations did not differ significantly in OS, PFS, ORR, DCR, or safety. In the Bayesian ranking analysis, the PD-1 inhibitor-based regimens Serplu-EP and Nivo-EP achieved the highest efficacy rankings; Serplu-EP ranked first for both OS and PFS, followed by Nivo-EP. Efficacy and safety were effectively balanced in Serplu-EP and Adebre-EP. Similar results were shown in subgroup analyses.
conclusionFirst-line ICI-chemotherapy combinations improved survival outcomes but increased the risk of irAEs, with no significant differences in efficacy or safety among ICI-chemotherapy combinations. Among the evaluated regimens, the PD-1 inhibitor-based Serplu-EP and Nivo-EP achieved the highest efficacy rankings, whereas Serplu-EP and Adebre-EP appeared to provide the most favorable efficacy-safety balance. Further head-to-head trials are warranted to confirm the optimal first-line ICI strategy for ES-SCLC.
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