Comparative effect of immunotherapy and standard therapy in patients with high grade glioma: a meta-analysis of published clinical trials

Abstract

Immunotherapy holds great promise in the treatment of high grade glioma (HGG). We performed a comprehensive meta-analysis of clinical trials involving dendritic cell (DC) therapy and viral therapy (VT) for the treatment of HGG, in order to assess their clinical impact in comparison to standard treatments in terms of overall survival (OS) and progression-free survival (PFS). To our knowledge, this is the first meta-analysis to evaluate VT for the treatment of HGG, allowing comparison of different immunotherapeutic approaches. Thirteen eligible studies of 1043 cases were included in the meta-analysis. For DC vaccination, in terms of OS, both newly diagnosed patients (HR, 0.65) and patients who suffered from recurrent HGGs (HR = 0.63) presented markedly improved results compared to the control groups. PFS was also improved (HR = 0.49) but was not statistically significant (p = 0.1). A slight improvement was observed for newly diagnosed patients receiving VT in terms of OS (HR = 0.88) while PFS was inferior for patients in the experimental arm (HR = 1.16). Our results show that DC therapy greatly improves OS for patients with both newly diagnosed and recurrent HGGs. VT, however, did not provide any statistically significant improvements in terms of OS and PFS for patients with newly diagnosed HGGs.

Figure 1

PRISMA flow diagram.

Figure 2

HR (Hazard Ratio) for OS (a) and PFS (b) for patients receiving DC vaccination versus standard therapy. The random effects model (Mantel-Haenszel method) was used for the analysis. HR = hazard ratio OS = overall survival DC = dendritic cell.

Figure 3

Funnel plot presenting the association between DC (a) and PFS (b) therapy and OS.

Figure 4

HR (Hazard Ratio) for OS (a) and PFS (b) for patients receiving VT versus standard therapy. The random effects model (Mantel-Haenszel method) was used for the analysis. HR = hazard ratio OS = overall survival VT = viral therapy.

Figure 5

Funnel plot presenting the association between VT therapy and OS (a) and PFS (b).