The efficacy and safety of the novel combination lenvatinib and pembrolizumab in endometrial cancer: A systematic review and single-arm meta-analysis.

Objective: Endometrial carcinoma is the most widespread gynecological cancer, with increasing morbidity and mortality. Pembrolizumab, a monoclonal antibody that targets PD1 receptor tumors, is approved for patients with microsatellite instability-high (MSI-H) solid tumors. Many clinical trials and observational studies have been conducted to assess the safety and efficacy of Lenvatinib and Pembrolizumab combination therapy in the setting of endometrial cancer. However, results have been inconsistent, and current data is based on a heterogeneous population. The primary objective was to assess the safety and efficacy of Lenvatinib plus Pembrolizumab for endometrial cancer. Data sources: The search was conducted from inception from four databases; PubMed, Google Scholar, the Cochrane Library, and ClinicalTrials.gov. The electronic database search was conducted from inception to August 20, 2023. Study eligibility criteria: We considered randomized controlled trials and single-arm observational studies, i.e. cohort, case-control and cross-sectional studies. Methodology: We performed a single-arm meta-analysis, involving 7 studies having a total of 495 patients with endometrial cancer were eventually included which had the following outcomes: Complete response, Partial response, Progression-free survival, stable disease, progressive disease, safety outcomes, Adverse events, and the total number of deaths. Results: Our results showed that 88.6 % of the patients were positive for non-MSI-H/pMMR tumors (95 % CI = 0.825-0.927) whereas 6.5 % (95 % CI = 3.8-9.8 %) of the patients for MSI-H/dMMR tumors. The pooled objective response of endometrial cancer patients treated with Lenvatinib and Pembrolizumab was 36.5 % (95 % CI = 0.258-0.471), the pooled estimate of complete and partial response was 47 % (95 % CI = 0.024-0.070) and 31.3 % (95 % CI = 0.230-0.396). 38.2 % patients had stable disease (95 % CI = 0.329-0.435) and 24.0 % patients had progressive disease (95 % CI = 0.103-0.378). The pooled median progression-free survival was 5.97 (95 % CI 5.43-7.63) months and, whereas the median overall survival was 17.19 months (95 % CI 15.34-19.31). All grade adverse events occurred in 85 % and Grade 3 or worse adverse events occurred in 39 % of patients during the therapy whereas death occurred in 23.8 % during the treatment. Conclusion: The results of this meta-analysis concludes that although the combined treatment of a Lenvatinib and Pembrolizumab had a PFS and OS that was inferior to the standard therapy used to treat advanced and recurrent endometrial cancer, it is still a novel treatment and shows potential for further research with a greater sample size.

Which vertebral level should be used to calculate sarcopenia in covid-19 patients? A systematic review and meta-analysis.

BACKGROUND & AIMS: Evidence shows that CT-derived sarcopenia can predict adverse outcomes in COVID-19 patients. However, discrepancies exist as to which vertebral level can be used to calculate sarcopenia which can effectively serve as a prognostic tool. Thus, we aim to investigate the difference in sarcopenia calculated at the Thoracic and Lumbar vertebral levels. METHODS: An online literature search was conducted on Electronic databases such as PubMed, Cochrane CENTRAL, and Google scholar. Meta-analysis was performed by using Revman 5.3 software. RESULTS: A total of 14 articles were selected for meta-analysis. The prevalence of sarcopenia calculated at the Thoracic level was 31% (95%CI 24%-37%; p < 0.00001; I2 = 86%), while sarcopenia calculated at the Lumbar vertebral level was 63% (95%CI 51%-75%; p < 0.00001; I2 = 88%). Meanwhile, sarcopenia calculated at the Upper thoracic level was a significant predictor of mortality OR 3.47 (95%CI 1.74-6.91; p = 0.0004; I2 = 56%)as compared to sarcopenia calculated at the lower thoracic OR 1.74 (95%Cl 0.91-3.33; p = 0.10; I2 = 60%)or lumbar level OR 2.49 (95%CI 0.45-13.72; p = 0.30; I2 = 57%). In addition to this sarcopenia calculated at the Upper thoracic level was also a significant predictor of severe illness OR 3.92 (95%CI 2.33-6.58; p < 0.00001; I2 = 0%) as compared to lower thoracic OR 1.40 (95%CI 0.78-2.53; p = 0.26; I2 = 67%) or lumbar level OR 1.64 (95%CI 0.26-10.50; p = 0.60; I2 = 81%) CONCLUSIONS: Sarcopenia calculated at the thoracic vertebrae and lumber level has different prognostic values. Sarcopenia is prevalent at the lumbar level. Sarcopenia at the thoracic level has a higher mortality and severity rate.

Predictors of Mortality in Acute Mesenteric Ischemia: A Systematic Review and Meta-Analysis.

INTRODUCTION: To highlight predictors of mortality in acute mesenteric ischemia (AMI) by conducting a meta-analysis of all relevant published studies. METHODS: PubMed, Cochrane, and Google Scholar were searched from their inception till October 31, 2021. Studies evaluating predictors of mortality were selected. Only those factors were selected for meta-analysis that was reported by at least four studies. Meta-analysis was performed on selected factors using the random-effects model by using Revman 5.3 software. RESULTS: Fifty-one studies were included evaluating 10,425 patients of AMI. Studies selected had a low risk of bias (Median = 7). Thirty-three factors were evaluated in our review. Age (OR 1.17, 95% CI 1.08-1.27), chronic renal disease (OR 2.47, 95% CI 1.37-4.45), patient dependency (OR 3.01, 95% CI 1.95-4.65), arrhythmias (OR 1.93, 95% CI 1.38-2.69), cardiac failure (OR 2.28, 95% CI 1.57-3.31), hypotension (OR 3.44, 95% CI 1.81-6.54), large bowel involvement (OR 2.98, 95% CI 1.44-6.17), small and large bowel involvement (OR 1.86, 95% CI 1.23-2.81), creatinine (OR 1.67, 95% CI 1.27-2.20), lactate (OR 1.43, 95% CI 1.26-1.62), delay to surgery (OR 2.51, 95% CI 1.58-3.99) and inotropes (OR 3.79, 95% CI 1.47-9.77) were significantly associated with mortality. On the contrary bowel wall thickening (OR 0.53, 95% CI 0.38-0.88), anticoagulation (OR 0.27, 95% CI 0.10-0.74), and revascularization (OR 0.30, 95% CI 0.13-0.69) were significantly associated with survival. CONCLUSIONS: In conclusion, Age, chronic renal disease, diabetes, patient dependency, arrhythmias, cardiac failure, hypotension, large bowel involvement, small & large bowel involvement, creatinine, lactate, delay to surgery, and inotropes were significantly associated with mortality while anticoagulants, revascularization and bowel thickening on CT was associated with decreased mortality.