Effects of various treatments for preventing oral mucositis in cancer patients: A network meta-analysis.

BACKGROUND: Oral mucositis (OM) is a common side effect of chemotherapy and radiotherapy in patients with cancers. The prevention or treatment of OM in cancer patients is crucial in the treatment of cancer. METHODS: We searched PubMed, Embase, and Cochrane Library for the randomized control trials (RCTs) of interventions for preventing and treating OM. Network meta-analysis (NMA) was performed to estimate odds ratios (ORs) and 95% confidence intervals (CI) from both direct and indirect evidence. The prespecified primary efficacy outcome was the treatment effect of moderate to severe oral mucositis with 12 interventions. The outcome was moderate to a severe grade of OM. RESULTS: This study included 55 RCTs with 3,552 participants. The results showed that honey significantly lowered the risk of chemo/radiotherapy-induced moderate to severe oral mucositis than placebo (OR: 0.01, 95%CI 0.00 to 0.45), followed by lignocaine (OR: 0.07, 95%CI 0.00 to 0.95). The surface under cumulative ranking curve (SUCRA) values for honey were 0.95, followed by lignocaine (SUCRA, 0.81) and benzydamine (SUCRA, 0.78). CONCLUSIONS: The honey is effective for patients with cancer undergoing chemotherapy or radiotherapy-induced oral mucositis.

Immune checkpoint inhibitors for first-line treatment of advanced non-small-cell lung cancer: A systematic review and network meta-analysis.

OBJECTIVE: Currently, several immune checkpoint inhibitors (ICIs) treatment for advanced non-small-cell lung cancer (NSCLC) have been investigated; their overall efficacy and safety remain unclear. METHODS: We searched electronic databases such as PubMed, EMBASE, and the Cochrane library. The randomized controlled trials (RCTs) that compared ICIs with or without chemotherapy to chemotherapy in advanced NSCLC. We collected and compaired thier parameters, including overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and treatment-related adverse events (TRAEs) of grade ≥3. RESULTS: A total of 15 RCTs involving 8869 patients with NSCLC were included. Pembrolizumab plus platinum-based chemotherapy had higher OS and PFS than platinum-based chemotherapy (hazard ratio [HR] 0.55, 95% CI 0.46-0.67; HR 0.54, 95% CI 0.41-0.70, respectively). Pembrolizumab plus platinum-based chemotherapy had higher ranked ORR than platinum-based chemotherapy (odds ratio [OR] 2.92, 95% CI 1.99-4.22). In terms of OS, atezolizumab, pembrolizumab plus platinum-based chemotherapy, and nivolumab plus ipilimumab ranked as the best treatments for patients with programmed death-ligand 1 (PD-L1) expression levels of ≥50%, 1-49%, and <1%, respectively. In terms of PFS, pembrolizumab plus platinum-based chemotherapy ranked as the best treatment for patients with any PD-L1 expression levels. However, ipilimumab plus platinum-based chemotherapy, nivolumab plus platinum-based chemotherapy, and atezolizumab plus platinum-based chemotherapy have higher TRAEs of grade ≥3 than platinum-based chemotherapy. CONCLUSIONS: Pembrolizumab plus platinum-based chemotherapy prevailed in rank in OS, PFS, and ORR benefit. The TRAEs of pembrolizumab plus platinum-based chemotherapy were more than ICI monotherapy and chemotherapy.

Indirect comparison between pembrolizumab and nivolumab for the treatment of non-small cell lung cancer: A meta-analysis of randomized clinical trials.

OBJECTIVE: The purpose of this study is to evaluate the efficacy and adverse effects of nivolumab and pembrolizumab for the treatment of advanced non-small-cell lung cancer (NSCLC) by meta-analysis. MATERIALS AND METHODS: This meta-analysis of randomized controlled trials (RCTs) was performed after searching PubMed, EMBASE, and American Society of Clinical Oncology meeting abstracts, clinicaltrial gov, and Cochrane library databases. Two reviewers independently assessed the quality of the trials. Outcomes analysis was overall response rates (ORR), overall survival (OS), progression- free survival (PFS) and major adverse effects with odds ratio (OR) or hazard ratio (HR) and 95% confidence intervals (CI). RESULTS: Results reported from three RCTs involving 1,887 patients are included in this analysis. Indirect comparison between pembrolizumab and nivolumab in advanced NSCLC shows no statistically significant difference in ORR (OR: 1.14, 95% CI, 0.60-2.01), OS (HR: 0.98, 95% CI, 0.35-2.74) and PFS (HR: 1.12, 95% CI, 0.70-1.77). The incidence of grades≥3 adverse effects is higher with pembrolizumab as compared with nivolumab (OR: 3.44, 95% CI, 1.87-6.32). There are no significant statistical differences between severe adverse effects, such as pneumonitis and hypothyroidism, of the two drugs. CONCLUSIONS: This study has demonstrated that pembrolizumab and nivolumab have similar survival outcomes in patients with advanced NSCLC, but pembrolizumab has a higher incidence of grades≥3 adverse effects than nivolumab.