SynthesisFrontiers in pharmacology2026
Efficacy and safety of first-line immunotherapy-related induction and maintenance therapy for extensive-stage small cell lung cancer: a systematic review and Bayesian network meta-analysis.
Synthesis in Frontiers in pharmacology, 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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Abstract
Background: Extensive-stage small cell lung cancer (ES-SCLC) is highly aggressive with dismal prognosis, and platinum monochemotherapy offers modest long-term survival. Multiple first-line regimens integrating immunotherapy, anti-angiogenic agents and chemotherapy have been approved, yet direct head-to-head comparisons are scarce, and the optimal induction plus maintenance strategy remains undefined. In this study, a Bayesian network meta-analysis (NMA) was performed to hierarchically assess the efficacy and safety of available first-line regimens and identify balanced treatment strategies for ES-SCLC. Methods: Eligible phase III randomized controlled trials (RCTs) were identified by searching PubMed, Embase, the Cochrane Library, and Web of Science. Trials were included if they enrolled treatment-naïve patients with ES-SCLC and reported at least one of the following outcomes: overall survival (OS), progression-free survival (PFS), or grade ≥3 treatment-related adverse events (TRAEs). NMA was implemented using the gemtc package in R. SUCRA values were calculated for treatment ranking, and subgroup analyses stratified by pharmacological mechanisms were conducted. Results: Fourteen RCTs involving 8,945 patients across 18 regimens were included in the present analysis. These trials encompassed diverse combinations of mainstream immune checkpoint inhibitors, anti-angiogenic targeted agents, and chemotherapeutic agents. The atezolizumab + lurbinectedin + chemotherapy and benmelstobart + anlotinib + chemotherapy regimens showed the greatest potential for superior PFS and OS compared with chemotherapy alone. Subgroup analyses confirmed sustained efficacy benefits for PD-L1 inhibitor-based triple-combination strategies. The nivolumab + ipilimumab regimen was associated with the highest risk of severe toxicity. Conclusion: PD-L1 inhibitor combined with platinum-based chemotherapy together with anti-angiogenic agents or lurbinectedin conferred optimal survival benefits, yet toxicity was correspondingly augmented. This study provides valuable insights into therapeutic drug selection for ES-SCLC. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261402898, identifier 420261402898.
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