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Meta-Analysis
. 2020 Oct 21;20(1):1021.
doi: 10.1186/s12885-020-07527-4.

Endostar continuous versus intermittent intravenous infusion combined with chemotherapy for advanced NSCLC: a systematic review and meta-analysis including non-randomized studies

Bo Wang  1 , Lu Xu  2 , Qihuan Li  1 , Sailimai Man  1   2 , Cheng Jin  3 , Lian Liu  4 , Siyan Zhan  5   6 , Yi Ning  7
Affiliations
Meta-Analysis

Endostar continuous versus intermittent intravenous infusion combined with chemotherapy for advanced NSCLC: a systematic review and meta-analysis including non-randomized studies

Bo Wang et al. BMC Cancer. .

Abstract

Background: Both intermittent intravenous (IIV) infusion and continuous intravenous (CIV) infusion of Endostar are widely used for NSCLC in China. We aimed to compare the efficacy and safety of CIV of Endostar versus IIV in combination with first-line chemotherapy for patients with advanced NSCLC.

Methods: RCTs, NRCTs and cohort studies which compared CIV of Endostar with IIV in advanced NSCLC patients and reported efficacy or safety outcomes were eligible. Two reviewers independently screened records, extracted data and assessed risk of bias. Pooled risk ratios (RRs) with 95% confidence intervals were calculated using random effects meta-analysis for short-term efficacy and safety outcomes, and hazard ratios (HRs) for survival outcomes.

Results: Finally nine studies involving 597 patients were included, containing two RCTs, three NRCTs and four cohort studies. For short-term efficacy, moderate quality of evidence showed that there were no significant differences between CIV of Endostar and IIV in objective response rate (ORR; RR 1.34, 95% CI 0.91-1.98, P = 0.14) and disease control rate (DCR; RR 1.11, 95% CI 0.94-1.30, P = 0.21). Very low quality of evidence indicated that CIV of Endostar significantly improved both overall survival (OS; HR 0.69, 95% CI 0.48-0.99, P = 0.046) and progression-free survival (PFS; HR 0.71, 95% CI 0.55-0.93, P = 0.01) compared with IIV. As for safety outcomes, moderate quality of evidence found that CIV of Endostar significantly reduced the risk of myelosuppression (RR 0.55, 95% CI 0.32-0.96, P = 0.03) and cardiovascular toxicity (RR 0.21, 95% CI 0.06-0.78, P = 0.02) compared with IIV.

Conclusions: In advanced NSCLC, compared with IIV, CIV of Endostar had similar short-term efficacy, and substantially lower risk of myelosuppression and cardiovascular toxicity. Although very low quality of evidence supported the survival benefit of CIV compared with IIV, large RCTs with long-term follow-up are needed to demonstrate survival benefits. Caution should be given for off-label use of CIV of Endostar.

Keywords: Endostar; Meta-analysis; Non-randomized studies; Non-small cell lung cancer; Recombinant human endostatin; Systematic review.

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Conflict of interest statement

The authors meet the criteria for authorship as recommended by the International Committee of Medical Journal Editors. The authors received no direct compensation related to the development of the manuscript. The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Selection of eligible studies
Fig. 2
Fig. 2
Forest plot of pooled RR of ORR for CIV compared with IIV from meta-analysis of studies with different study designs
Fig. 3
Fig. 3
Forest plot of pooled RR of DCR for CIV compared with IIV from meta-analysis of studies with different study designs
Fig. 4
Fig. 4
Forest plot of pooled HR of OS for CIV compared with IIV from meta-analysis of cohort studies
Fig. 5
Fig. 5
Forest plot of pooled HR of PFS for CIV compared with IIV from meta-analysis of cohort studies
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References

    1. International Agency for Research on Cancer. Cancer Today: Fact sheets. 2019. http://gco.iarc.fr/today/data/factsheets/cancers/15-Lung-fact-sheet.pdf. Accessed 20 Mar, 2020.
    1. She J, Yang P, Hong Q, Bai C. Lung cancer in China: challenges and interventions. Chest. 2013;143(4):1117–1126. doi: 10.1378/chest.11-2948. - DOI - PubMed
    1. Osmani L, Askin F, Gabrielson E, Li QK. Current WHO guidelines and the critical role of immunohistochemical markers in the subclassification of non-small cell lung carcinoma (NSCLC): moving from targeted therapy to immunotherapy. Semin Cancer Biol. 2018;52(Pt 1):103–109. doi: 10.1016/j.semcancer.2017.11.019. - DOI - PMC - PubMed
    1. Pilkington G, Boland A, Brown T, Oyee J, Bagust A, Dickson R. A systematic review of the clinical effectiveness of first-line chemotherapy for adult patients with locally advanced or metastatic non-small cell lung cancer. Thorax. 2015;70(4):359–367. doi: 10.1136/thoraxjnl-2014-205914. - DOI - PubMed
    1. Ling Y, Yang Y, Lu N, You QD, Wang S, Gao Y, et al. Endostar, a novel recombinant human endostatin, exerts antiangiogenic effect via blocking VEGF-induced tyrosine phosphorylation of KDR/Flk-1 of endothelial cells. Biochem and Biophys Res Commun. 2007;361(1):79–84. doi: 10.1016/j.bbrc.2007.06.155. - DOI - PubMed

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