SynthesisFrontiers in neurology2026
Comparative efficacy of therapeutic strategies for recurrent or refractory glioblastoma: a systematic review and network meta-analysis.
Synthesis in Frontiers in neurology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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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.
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.
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Authors and funding
7 authors.
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Abstract
Background: Recurrent or refractory glioblastoma has a poor prognosis, and no universally accepted standard treatment has been established. Randomized evidence is fragmented, making pairwise comparisons insufficient. This study aimed to compare available treatments using a frequentist network meta-analysis. Methods: PubMed, Web of Science, and the Cochrane Library were searched from inception to April 2026 for randomized controlled trials involving adults with recurrent or refractory glioblastoma. Prespecified outcomes were progression-free survival (PFS), overall survival (OS), and objective response rate (ORR). Hazard ratios (HRs) were used for PFS and OS, and odds ratios (ORs) for ORR. Random-effects frequentist network meta-analyses were conducted, with P-scores used as exploratory rankings. Sensitivity analyses excluded trials with fewer than 20 patients in any treatment arm. The protocol was registered with PROSPERO (CRD420261398465). Results: Twenty-four studies were included in the qualitative synthesis, of which 19 contributed to at least one network meta-analysis. Compared with lomustine, bevacizumab plus lomustine significantly improved PFS (HR = 0.57, 95% CI: 0.40-0.80), and remained significant after excluding small trials (HR = 0.58, 95% CI: 0.34-0.97). Bevacizumab plus vorinostat had the highest numerical P-score for PFS, although its effect was not statistically significant. No intervention showed a statistically significant OS advantage over bevacizumab. Rindopepimut plus bevacizumab had the most favorable numerical OS estimate (HR = 0.53, 95% CI: 0.23-1.21), but this was non-significant and derived from an EGFRvIII-positive population. No treatment significantly improved ORR versus bevacizumab, whereas nivolumab was associated with lower odds of response (OR = 0.28, 95% CI: 0.14-0.57). Excluding small trials had limited influence on PFS and OS findings but altered the ORR ranking by removing the highly ranked ERC1671-based regimen. Conclusion: Bevacizumab plus lomustine showed the clearest PFS benefit, but the absence of an OS benefit precludes interpretation as broadly superior. No treatment showed a confirmed OS advantage, and the favorable numerical signal for rindopepimut plus bevacizumab should not be generalized beyond EGFRvIII-positive patients. P-score rankings should be considered exploratory and interpreted alongside effect estimates, confidence intervals, sample sizes, molecular eligibility, safety, and treatment burden. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261398465, Identifier: CRD420261398465.
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