Association of proton-density fat fraction with osteoporosis: a systematic review and meta-analysis.

This study aimed to evaluate the correlation between measuring proton-density fat fraction (PDFF) in bone marrow using multi-echo chemical shift-encoded MRI and osteoporosis, assessing its effectiveness as a biomarker for osteoporosis. A systematic review was conducted by two independent researchers using Cochrane, PubMed, EMBASE, and Web of Science databases up to December 2023. Quality assessments were evaluated using the Cochrane risk of bias tool and the Agency for Healthcare Research and Quality (AHRQ) checklist. Fourteen studies involving 1495 patients were analyzed. The meta-analysis revealed a significant difference in PDFF values between the osteoporosis/osteopenia group and the normal control group, with a mean difference of 11.04 (95% CI: 9.17 to 12.92, Z=11.52, P < 0.00001). Measuring PDFF via MRI shows potential as an osteoporosis biomarker and may serve as a risk factor for osteoporosis. This insight opens new avenues for future diagnostic and therapeutic strategies, potentially improving osteoporosis management and patient care. OBJECTIVE: This study aims to assess the correlation between measuring proton-density fat fraction (PDFF) in bone marrow using multi-echo chemical shift-encoded MRI and osteoporosis, evaluating its effectiveness as a biomarker for osteoporosis. MATERIALS AND METHODS: This systematic review was carried out by two independent researchers using Cochrane, PubMed, EMBASE, and Web of Science databases up to December 2023. Quality assessments were evaluated using the Cochrane risk of bias tool and the Agency for Healthcare Research and Quality (AHRQ) checklist. RESULTS: Fourteen studies involving 1495 patients were analyzed. The meta-analysis revealed a significant difference in PDFF values between the osteoporosis/osteopenia group and the normal control group, with a (MD = 11.04, 95% CI: 9.17 to 12.92, Z = 11.52, P < 0.00001). Subgroup analyses indicated that diagnostic methods, gender, and echo length did not significantly impact the PDFF-osteoporosis association. CONCLUSION: PDFF measurement via MRI shows potential as an osteoporosis biomarker and may serve as a risk factor for osteoporosis. This insight opens new avenues for future diagnostic and therapeutic strategies, potentially improving osteoporosis management and patient care.

PD-1/PD-L1 inhibitor plus chemotherapy versus standard of care in the first-line treatment for recurrent or metastatic head and neck squamous cell carcinoma.

OBJECTIVE: This study aimed to evaluate the efficacy and safety of programmed cell death-1/programmed cell death-ligand 1 (PD-1/PD-L1) inhibitor plus chemotherapy vs standard of care (SoC) treatment in the first-line treatment for recurrent or metastatic head and neck squamous cell carcinoma (R/M-SCCHN). METHODS: Randomized controlled trials (RCTs) that investigated PD-1/PD-L1 inhibitor plus chemotherapy vs SoC as first-line treatment for R/M-SCCHN were searched from electronic databases (PubMed, Embase and Cochrane Library). The primary outcomes were overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and adverse events (AEs). RESULTS: In total, three phase 3 RCTs (KEYNOTE-048, CAPTAIN-1st, and JUPITER-02; n = 1120) with three PD-1 inhibitors (pembrolizumab, camrelizumab and toripalimab) were included in the analysis. Compared with SoC, PD-1 inhibitor plus chemotherapy significantly prolonged PFS (hazard ratio [HR] 0.66, 95% CI 0.40-0.93, p < 0.001) and OS (HR 0.73, 95% CI 0.60-0.86, p < 0.001) of patients. There was no statistical differences in ORR (odds ratio [OR] 1.26; 95% CI 0.97-1.64, p = 0.086), grade 3 or higher AEs (OR 0.77, 95% CI 0.50-1.17, p = 0.221), and treatment-related deaths (OR 1.34, 95% CI 0.60-2.98, p = 0.470) between the two groups. CONCLUSION: PD-1 inhibitor plus chemotherapy showed more survival benefit than SoC in the first-line treatment for R/M-SCCHN, with a similar safety profile.

Development of a novel MR-conditional microwave needle for MR-guided interventional microwave ablation at 1.5T.

PURPOSE: To develop an MR-conditional microwave needle that generates a spherical ablation zone and clear MRI visibility for MR-guided microwave ablation. METHODS: An MR-conditional microwave needle consisting of zirconia tip and TA18 titanium alloy tube was investigated. The numerical model was created to optimize the needle's geometry and analyze its performance. A geometrically optimized needle was produced using non-magnetic materials based on the electromagnetics simulation results. The needle's mechanical properties were tested per the Chinese pharmaceutical industry standard YY0899-2013. The MRI visibility performance and ablation characteristics of the needle was tested both in vitro (phantom) and in vivo (rabbit) at 1.5T. The RF-induced heating was evaluated in ex vivo porcine liver. RESULTS: The needle's mechanical properties met the specified requirements. The needle susceptibility artifact was clearly visible both in vitro and in vivo. The needle artifact diameter (A) was small in in vivo (Ashaft: 4.96 ± 0.18 mm for T1W-FLASH, 3.13 ± 0.05 mm for T2-weighted fast spin-echo (T2W-FSE); Atip: 2.31 ± 0.09 mm for T1W-FLASH, 2.29 ± 0.08 mm for T2W-FSE; tip location error [TLE]: -0.94 ± 0.07 mm for T1W-FLASH, -1.10 ± 0.09 mm for T2W-FSE). Ablation zones generated by the needle were nearly spherical with an elliptical aspect ratio ranging from 0.79 to 0.90 at 30 W, 50 W for 3, 5, 10 min duration ex vivo ablations and 0.86 at 30 W for 10 min duration in vivo ablations. CONCLUSION: The designed MR-conditional microwave needle offers excellent mechanical properties, reliable MRI visibility, insignificant RF-induced heating, and a sufficiently spherical ablation zone. Further clinical development of MR-guided microwave ablation appears warranted.

The efficacy and safety of immune checkpoint inhibitor plus chemotherapy in patients with advanced non-small-cell lung cancer: a meta-analysis.

OBJECTIVE: To evaluate the efficacy and safety of immune checkpoint inhibitor (ICI) and chemotherapy (CT) versus CT alone in advanced non-small-cell lung cancer (NSCLC). METHODS: Databases (PubMed, Embase and Cochrane Library) were searched for relevant randomized controlled trials (RCTs). Clinical outcome measures including overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and grade 3-5 treatment-related adverse events (AEs) were analyzed by Stata 15.0 software; significance level was 0.05. RESULTS: Eight RCTs involving 4227 patients were included. The results showed ICI + CT significantly improved OS (hazard ratio [HR] = 0.74, 95% CI: 0.62-0.85, p < 0.001), PFS (HR = 0.66, 95% CI: 0.57 - 0.75, p < 0.001) and ORR (odds ratio [OR] = 1.89; 95% CI, 1.43-2.49, p < 0.001) compared with CT alone. Subgroup analysis indicated that significantly longer OS was also observed in subgroups including combination regimens (pembrolizumab + CT, atezolizumab + CT, ipilimumab + CT, and nivolumab + ipilimumab + CT) and PD-L1 status [negative (< 1%), positive (≥ 1%), low (1-49%) and high (≥ 50%)]. However, ICI + CT showed signifcantly higher grade 3-5 treatment-related AEs than CT (OR = 1.46, 95% CI: 1.19 - 1.79, p < 0.001). CONCLUSIONS: ICI + CT showed better clinical efficacy than CT alone in patients with advanced NSCLC, with increased treatment-related AEs.

LINC01806 mediated by STAT1 promotes cell proliferation, migration, invasion, and stemness in non-small cell lung cancer through Notch signaling by miR-4428/NOTCH2 axis.

BACKGROUND: Non-small cell lung cancer (NSCLC), the most primary lung cancer subtype, threatens human health globally. Long non-coding RNAs (lncRNAs) have been uncovered to affect multiple cancers progression. Nevertheless, the specific function of long intergenic non-protein coding RNA 1806 (LINC01806) in NSCLC remains elusive. METHODS: RT-qPCR and western blot were involved in this study. The influence of LINC01806 on NSCLC was assessed by in vitro and in vivo assays. Via ChIP, RNA pull down, RIP, and luciferase reporter assays, the in-depth cellular mechanisms of LINC01806 in NSCLC were explored. RESULTS: LINC01806 expression was high in NSCLC cell lines. Functionally, LINC01806 knockdown impeded cell proliferation, migration, invasion, and stemness, along with tumor growth. As for its mechanism, signal transducer and activator of transcription 1 (STAT1) activated LINC01806 transcription in NSCLC. Furthermore, LINC01806 sequestered microRNA-4428 (miR-4428) to enhance notch receptor 2 (NOTCH2) expression, thus activating Notch signaling pathway. Finally, in vitro and in vivo assays jointly validated that LINC01806 exerted its function in NSCLC development via miR-4428/NOTCH2 pathway. CONCLUSION: LINC01806 enhanced NOTCH2 expression to stimulate Notch signaling via sponging miR-4428, thereby facilitating NSCLC progression, which provided a novel mechanism for NSCLC therapeutic approaches.

Combination therapy with immune checkpoint inhibitors in advanced renal cell carcinoma: A meta-analysis of randomized controlled trials.

PURPOSE: To evaluate the efficacy and safety of immune checkpoint inhibitor combination therapy in advanced renal cell carcinoma (RCC). METHODS: We searched PubMed/Embase/Cochrane Library for relevant randomized controlled trials (RCTs). Clinical outcome measures including overall survival (OS), progression-free survival (PFS), objective response rates (ORRs), and adverse events (AEs) were analyzed by Stata 15.1 software. RESULTS: Seven RCTs involving 3461 patients were included. The pooled hazard ratios of OS and PFS for combination therapy were 0.67 (0.53-0.82, p < 0.001) and 0.68 (0.52-0.83, p < 0.001), respectively. Longer OS and PFS for combination therapy was also observed in the PD-L1 expression leve ≥1% group. The pooled odds ratios of ORRs and grade 3 or higher AEs were 2.31 (1.61-3.32, p < 0.001) and 0.94 (0.65-1.37, p = 0.753), respectively. CONCLUSIONS: Immune checkpoint inhibitor combination therapy showed more clinical benefit in the first-line treatment for advanced RCC, with a safety profile.

LncRNA FEZF1-AS1 promotes non-small lung cancer cell migration and invasion through the up-regulation of NOTCH1 by serving as a sponge of miR-34a.

BACKGROUND: The involvement of lncRNA FEZF1-AS1 has been analyzed in many types of cancers, while its roles in non-small cell lung cancer (NSCLC) remains unclear. We then explored the role of FEZF1-AS1 in NSCLC. METHODS: qPCR and western blot were performed to measure gene expression. FEZF1-AS1, miR-34a, and NOTCH-1 were overexpressed to analyze the relationship between them. Transwell assays were performed to analyze the effects of transfections on cell invasion and migration. RESULTS: FEZF1-AS1 was up-regulated in NSCLC patients. Increased expression levels of FEZF1-AS1 were observed with the increase in clinical stages. Bioinformatics analysis showed that miR-34a can bind with FEZF1-AS1. In NSCLC tissues, NOTCH-1 and FEZF1-AS1 were positively correlated. In NSCLC cells, over-expression of FEZF1-AS1 resulted in up-regulated expressions of NOTCH-1, while miR-34a over-expression mediated down-regulated expressions of NOTCH-1. In addition, FEZF1-AS1 and miR-34a did not alter each other, while bioinformatics analysis showed that miR-34a can bind FEZF1-AS1. Analysis of cell migration and invasion showed increased cell invasion and migration rates after FEZF1-AS1 and NOTCH-1 over-expression. MiR-34a played the opposite role and reduced the effects of FEZF1-AS1 over-expression. CONCLUSIONS: FEZF1-AS1 promoted NSCLC cell migration and invasion through the up-regulation of NOTCH1 by serving as a sponge of miR-34a.

A novel method for highly linear gradient coil design based on stream function.

BACKGROUND: Magnetoencephalography (MEG) and magnetic resonance imaging (MRI) are non-invasive imaging techniques that offer effective means for disease diagnosis. A more straightforward and optimized method is presented for designing gradient coils which are pivotal parts of the above imaging systems. PURPOSE: A novel design method based on stream function combining an optimization algorithm is proposed to obtain highly linear gradient coil. METHODS: Two-dimensional Fourier expansion of the current field on the surface where the coil is located and the equipotential line of the expansion term superposition according to the number of turns of the coil are used to represent the coil shape. Particle swarm optimization is utilized to optimize the coil shape while linearity and field uniformity are used as parameters to evaluate the coil performance. Through this method, the main parameters such as input current distribution region, coil turns, desired magnetic field strength, expansion order and iteration times can be combined in a given solution space to optimize coil design. RESULTS: Simulation results show that the maximum linearity spatial deviation of the designed bi-planar x-gradient coil compared with that of target field method is reduced from 14% to 0.54%, and that of the bi-planar z-gradient coil is reduced from 8.98% to 0.52%. Similarly, that of the cylindrical x-gradient coil is reduced from 2% to 0.1%, and that of the cylindrical z-gradient coil is reduced from 0.87% to 0.45%. The similar results are found in the index of inhomogeneity error. Moreover, it has also been verified experimentally that the result of measured magnetic field is consist with simulated result. CONCLUSIONS: The proposed method provides a straightforward way that simplifies the design process and improves the linearity of designed gradient coil, which could be beneficial to realize better magnetic field in engineering applications.

Effect of Mineral Admixtures on the Mechanical and Shrinkage Performance of MgO Concrete.

Shrinkage deformation of concrete has been one of the difficulties in the process of concrete performance research. Cracking of concrete caused by self-shrinkage and temperature-drop shrinkage has become a common problem in the concrete world, and cracking leads to a decrease in the durability of concrete and even a safety hazard. Mineral admixtures, such as fly ash and mineral powder, are widely used to improve the temperature drop shrinkage of mass concrete; fly ash can reduce the temperature rise of concrete while also reducing the self-shrinkage of concrete, there are different results on the effect of mineral powder on the self-shrinkage of concrete, but the admixture of fly ash will reduce the strength of concrete, and mineral admixtures have an inhibitory effect on the shrinkage compensation effect of MgO expander(MEA). The paper investigates the effect of mineral admixtures on the mechanical and deformation properties of C50 mass concrete with a MgO expander(MEA), aiming to determine the proportion of C50 mass concrete with good anti-cracking properties under working conditions. The experiments investigated the effect of fly ash admixture, mineral powder admixture and MgO expander admixture on the compressive strength and deformation of concrete under simulated working conditions of variable temperature and analyzed the effect of hydration of magnesite in MgO expander and pore structure of cement paste on deformation. The following main conclusions were obtained: 1. When the concrete compounded with mineral admixture was cured under variable temperature conditions, the compounded 30% fly ash and mineral powder decreased by 4.3%, 6.0% and 8.4% at 7d age, and the compounded 40% fly ash and mineral powder decreased by 3.4%, 2.8% and 2.3% at 7d age, respectively. The incorporation of MEA reduced the early compressive strength of concrete; when the total amount of compounding remained unchanged, the early compressive strength of concrete was gradually smaller as the proportion of compounding decreased. 2. The results of concrete deformation showed that when the temperature rose, the concrete expanded rapidly, and when the temperature dropped, the concrete also showed a certain shrinkage, and the deformation of concrete basically reached stability at 18d. 3. The compounding of 30% fly ash and mineral powder As the compounding ratio decreases, the deformation of concrete increases, and the 28d deformation of concrete with a compounding ratio of 2:1 is 280 × 10-6, while the final stable deformation of concrete with a compounding ratio of 2:1 in compounding 40% fly ash and mineral powder is the largest, with a maximum value of 230 × 10-6, respectively. Overall, the concrete with a total compounding of 30% and a compounding ratio of 2:1 has the best shrinkage resistance performance.

Effect of Hydration Temperature Rise Inhibitor on the Temperature Rise of Concrete and Its Mechanism.

The rapid drop in internal temperature of mass concrete can readily lead to temperature cracks. Hydration heat inhibitors reduce the risk of concrete cracking by reducing the temperature during the hydration heating phase of cement-based material but may reduce the early strength of the cement-based material. Therefore, in this paper, the influence of commercially available hydration temperature rise inhibitors on concrete temperature rise is studied from the aspects of macroscopic performance and microstructure characteristics, and their mechanism of action is analyzed. A fixed mix ratio of 64% cement, 20% fly ash, 8% mineral powder and 8% magnesium oxide was used. The variable was different admixtures of hydration temperature rise inhibitors at 0%, 0.5%, 1.0% and 1.5% of the total cement-based materials. The results showed that the hydration temperature rise inhibitors significantly reduced the early compressive strength of concrete at 3 d, and the greater the amount of hydration temperature rise inhibitors, the more obvious the decrease in concrete strength. With the increase in age, the influence of hydration temperature rise inhibitor on the compressive strength of concrete gradually decreased, and the decrease in compressive strength at 7 d was less than that at 3 d. At 28 d, the compressive strength of the hydration temperature rise inhibitor was about 90% in the blank group. XRD and TG confirmed that hydration temperature rise inhibitors delay early hydration of cement. SEM showed that hydration temperature rise inhibitors delayed the hydration of Mg(OH)2.

Effect of Curing Conditions on the Hydration of MgO in Cement Paste Mixed with MgO Expansive Agent.

Using the volume expansion generated by the hydration of the MgO expansive agent to compensate for the shrinkage deformation of concrete is considered to be an effective measure to prevent concrete shrinkage and cracking. Existing studies have mainly focused on the effect of the MgO expansive agent on the deformation of concrete under constant temperature conditions, but mass concrete in practical engineering experiences a temperature change process. Obviously, the experience obtained under constant temperature conditions makes it difficult to accurately guide the selection of the MgO expansive agent under actual engineering conditions. Based on the C50 concrete project, this paper mainly investigates the effect of curing conditions on the hydration of MgO in cement paste under actual variable temperature conditions by simulating the actual temperature change course of C50 concrete so as to provide a reference for the selection of the MgO expansive agent in engineering practice. The results show that temperature was the main factor affecting the hydration of MgO under variable temperature curing conditions, and the increase in the temperature could obviously promote the hydration of MgO in cement paste, while the change in the curing methods and cementitious system had an effect on the hydration of MgO, though this effect was not obvious.

Severe and fatal adverse events of immune checkpoint inhibitor combination therapy in patients with metastatic renal cell carcinoma: a systematic review and meta-analysis.

Introduction: Immune checkpoint inhibitor (ICI) combination therapy has changed the treatment landscape for metastatic renal cell carcinoma (mRCC). However, little evidence exists on the treatment-related severe adverse events (SAEs) and fatal adverse events (FAEs) of ICI combination therapy in mRCC. Method: We searched PubMed, Embase, and Cochrane Library databases to evaluate randomized controlled trials (RCTs) of ICI combination therapy versus conventional tyrosine kinase inhibitor (TKI)-targeted therapy in mRCC. Data on SAEs and FAEs were analyzed using revman5.4 software. Results: Eight RCTs (n=5380) were identified. The analysis showed no differences in SAEs (60.5% vs. 64.5%) and FAEs (1.2% vs. 0.8%) between the ICI and TKI groups (odds ratio [OR], 0.83; 95%CI 0.58-1.19, p=0.300 and OR, 1.54; 95%CI 0.89-2.69, p=0.120, respectively). ICI-combination therapy was associated with less risk of hematotoxicities, including anemia (OR, 0.24, 95%CI 0.15-0.38, p<0.001), neutropenia (OR, 0.07, 95%CI 0.03-0.14, p<0.001), and thrombocytopenia (OR, 0.05, 95%CI 0.02-0.12, p<0.001), but with increased risks of hepatotoxicities (ALT increase [OR, 3.39, 95%CI 2.39-4.81, p<0.001] and AST increase [OR, 2.71, 95%CI 1.81-4.07, p<0.001]), gastrointestinal toxicities (amylase level increase [OR, 2.32, 95%CI 1.33-4.05, p=0.003] and decreased appetite [OR, 1.77, 95%CI 1.08-2.92, p=0.020]), endocrine toxicity (adrenal insufficiency [OR, 11.27, 95%CI 1.55-81.87, p=0.020]) and nephrotoxicity of proteinuria (OR, 2.21, 95%CI 1.06-4.61, p=0.030). Conclusions: Compared with TKI, ICI combination therapy has less hematotoxicity in mRCC but more specific hepatotoxicity, gastrointestinal toxicity, endocrine toxicity, and nephrotoxicity, with a similar severe toxicity profile. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42023412669.

Polystyrene microplastics induced male reproductive toxicity and transgenerational effects in freshwater prawn.

Microplastics have become pervasive environmental pollutants, especially in freshwater rivers and lakes. However, how freshwater prawns' reproductive system is affected by polystyrene microplastics (PS-MPs) remains incompletely understood. Thus, the present study aimed to determine the effect of PS-MPs on the male reproductive system and offspring larval immunity in oriental river prawn. Acute exposure to PS-MPs decreased the survival rate and heart rate of prawn larvae. After chronic exposure to PS-MPs (2 and 20 mg/L) for four weeks, the oxidative stress generation in testis tissue indicated a negative impact on male prawn testicular function. PS-MPs disrupted testicular germ cell quality and caused sex hormone imbalance, leading to reduced hatching success and survival of F1 larvae, despite not being exposed to PS-MPs. Steroidogenic gene expression was altered and apoptosis-related genes had higher expression in the gonads after parental exposure to PS-MPs. Decreased immunity-related enzyme activities were observed in F1 larvae with/without continued PS-MPs exposure, compared with those in untreated prawns. A concentration-dependent increase in bioaccumulation of PS-MPs in different tissues of larval offspring was observed. Thus, PS-MPs had multiple effects on male reproductive dysfunction and transgenerational toxicity in prawns. Our findings provide a novel insight into the reproductive toxicity mechanism of microplastics in freshwater crustaceans.

Efficacy of immune checkpoint inhibitor as maintenance therapy for advanced or metastatic cancers: A meta-analysis of randomized controlled trials.

BACKGROUND: This study aimed to evaluate the efficacy of immune checkpoint inhibitors (ICIs) as maintenance therapy for advanced or metastatic cancers. METHODS: The PubMed, Embase, and Cochrane Library databases were searched for eligible randomized controlled trials. A meta-analysis of eligible studies investigating the outcomes including progression-free survival (PFS), overall survival (OS), and objective response rate (ORR) with a significance level set to 0.05 was performed. RESULTS: Five RCTs (n = 2828) were identified in this analysis. The pooled hazard ratios (HRs) of PFS and OS for ICI maintenance therapy were 0.88 (95% CI: 0.68-1.13, P = .31) and 0.82 (95% confidence interval [CI]: 0.74-0.92, P = .0005), respectively; the pooled odds ratio (OR) of ORR was 2.24 (95% CI: 1.23-4.09, P = .0008). Subgroup analysis indicated that anti-PD-L1 antibody significantly improved the OS (P = .0008), while anti-PD-1 and anti-PD-1 plus anti-cytotoxic T lymphocyte antigen 4 antibodies significantly prolonged the PFS of patients. CONCLUSION: ICI maintenance therapy enhanced the survival of patients with advanced or metastatic cancers.

Efficacy and safety of adjuvant therapy with PD­1/PD­L1 inhibitors in cancer.

Anti-programmed cell death protein-1 (PD-1)/programmed cell death 1 ligand 1 (PD-L1) antibodies have been widely used in cancers. The present study aimed to evaluate the efficacy and safety of PD-1/PD-L1 inhibitors in human cancers. Studies were searched from Cochrane Library, PubMed and Embase databases. Randomized controlled trials (RCTs) that investigated adjuvant therapy with anti-PD-1/PD-L1 agents in solid cancers were eligible for inclusion. As the primary focus of the meta-analysis, clinical outcome measures including overall survival (OS), disease-free survival (DFS), and adverse events (AEs) were analyzed by Stata 15.0 software. A total of six RCTs (n=4,436) met the inclusion criteria. The DFS [hazard ratio (HR)=0.71; 95% confidence interval (CI): 0.63-0.78; P<0.001] and OS (HR=0.66, 95% CI: 0.46-0.86, P<0.001) of patients were significantly prolonged by adjuvant immunotherapy. Subgroup analysis indicated that significantly improved DFS was observed in patients treated with different anti-PD-1/PD-L1 drugs (nivolumab, pembrolizumab, or atezolizumab), as well as in those with different tumors (melanoma, urothelial carcinoma, esophageal or gastroesophageal junction cancer, or renal cell carcinoma), and PD-L1 status [negative (<1%) or positive (≥1%)]. However, PD-1/PD-L1 inhibitors was associated with increased ≥ grade 3 treatment-related AEs (odds ratio=1.63; 95% CI: 1.20-2.21; P=0.002). The available evidence suggests that adjuvant therapy with PD-1/PD-L1 inhibitors provided more survival benefit than placebo for patients with cancer, with increased grade 3 or higher AEs. Prospero registration no. CRD42021290654.

The efficacy and safety of combination therapy with immune checkpoint inhibitors in non-small cell lung cancer: A meta-analysis.

PURPOSE: Combination therapies with immune checkpoint blockade demonstrate promising antitumor activity and safety in Non-small Cell Lung Cancer (NSCLC). However, whether the combination therapy is superior to their monotherapies, and which combination regimen is most efficacious remain unknown. This meta-analysis aims to synthesize the current available evidences on the efficacy and safety of combination immunotherapy in patients with NSCLC. METHODS: PubMed, Embase and Cochrane Library were searched. Randomized controlled trials (RCTs) investigating combination therapy with immune checkpoint inhibitors in NSCLC were included. RESULTS: We identified nine RCTs including a total of 5,142 patients. The study showed that the pooled hazard ratios (HRs) of overall survival (OS) and progression-free survival (PFS) for combination therapy were 0.74 (95% CI: 0.63-0.86, p = 0.001) and 0.65 (95% CI: 0.56-0.73, p = 0.004); the pooled odds ratios (ORs) of objective response rates (ORRs) and grade 3 or higher adverse events (AEs) were 1.51 (95% CI: 1.02-1.99, p < 0.001) and 1.30 (95% CI: 1.03-1.57, p = 0.007). Subgroup analysis showed that the OR of grade 3 or higher AEs for immunotherapy plus chemotherapy was higher than that of chemotherapy alone, but did not reach statistical significance (p = 0.061) , and there was PFS and OS benefit for either immunotherapy plus chemotherapy, double agent immunotherapy or immunotherapy plus targeted plus chemotherapy combination regimens. CONCLUSIONS: Combination therapy with immune checkpoint inhibitors showed more clinical benefit for patients with NSCLC, with increased grade 3 or higher AEs, but toxicities were manageable.

Safety and efficacy of pembrolizumab plus lenvatinib versus pembrolizumab and lenvatinib monotherapies in cancers: A systematic review.

OBJECTIVE: Both pembrolizumab and lenvatinib demonstrate antitumor activity and safety in cancers. However, whether their combination is safer and more effective than monotherapies remains unknown. A systematic review was performed to assess the safety and efficacy of pembrolizumab plus lenvatinib versus their respective monotherapies in solid cancers. METHODS: PubMed, Embase, and Cochrane Library were searched. Forty-two clinical trials with 8155 patients were included. RESULTS: The total ≥grade 3 adverse events (AEs) and objective response rates (ORRs) among pembrolizumab plus lenvatinib and pembrolizumab or lenvatinib monotherapies in solid cancers were 68.0% vs 17.7% vs 68.5% and 40.6% vs 20.8% vs 43.3%, respectively. The most common AEs of pembrolizumab plus lenvatinib were hypertension (20-61.1%), fatigue (12-59.1%), diarrhea (9-51.9%), hypothyroidism (25-47%), and proteinuria (8-17%). Good ORRs for combination therapy were observed in renal cell carcinoma (70%), gastric cancer (69%), melanoma (48%), head and neck squamous cell carcinoma (46%), and endometrial cancer (38-53%), while these rates were reported as 27%, 11.6-22%, 26-37%, 14.6-23%, and 11-14.3% for monotherapies, respectively. Longer median progression-free survival (mPFS) and median overall survival (mOS) were observed for hepatocellular carcinoma (mPFS 9.3 months, mOS 22.0 months), renal cell carcinoma (mPFS 19.8 months), gastric cancer (mPFS 7.1 months, mOS not reached), and endometrial cancer (mPFS 7.4 months, mOS 16.7 months). CONCLUSIONS: Compared with their monotherapies, pembrolizumab plus lenvatinib showed more promising antitumor activity and resulted in higher ORRs and significant survival benefits in the above cancers. Toxicities were manageable, with no unexpected safety issues.