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  • American Society of Clinical Oncology (ASCO)  (2)
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  • American Society of Clinical Oncology (ASCO)  (2)
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  • 1
    Online Resource
    Online Resource
    Efficacy and toxicity of neoadjuvant immune checkpoint inhibitors in resectable gastric cancer: A meta-analysis and systematic review.
    American Society of Clinical Oncology (ASCO) ; 2022
    In:  Journal of Clinical Oncology Vol. 40, No. 4_suppl ( 2022-02-01), p. 291-291
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 40, No. 4_suppl ( 2022-02-01), p. 291-291
    Abstract: 291 Background: Immune checkpoint inhibitors (ICI) have made significant breakthroughs in late-stage gastric cancer. It is an attractive issue whether ICIs also function in the neoadjuvant setting. Methods: A systematic review was performed using combined terms related to “stomach cancer”, “gastric cancer”, “gastroesophageal cancer”, “immune checkpoint inhibitor”, “PD-1”, “PD-L1” and “neoadjuvant” in PubMed and annual meeting of ASCO, ASCO GI, ESMO, and ESMO GI from 2019 to 2021. Complete pathological response (CPR) rates, major pathological response (MPR) rates, R0 resection rates, and side effects were pooled and analyzed. MPR was defined as ≤10% viable tumor cells and included CPR. Study outcomes were pooled using the function METAPHOR in the META package in R.3.6.1. The I 2 and P statistics were used to evaluate heterogeneity among studies. Funnel plots were used for publication bias assessment. Results: A total of 13 phase I/II clinical trials, including 332 resectable gastric cancer (T2-4 or N+) patients with neoadjuvant ICI-containing treatments, were collected. The pooled rates of CPR, MPR, and R0 resection were 0.16 (95% credible intervals (CI), 0.12-0.22), 0.36 (95% CI, 0.24-0.51), and 0.97 (95% CI, 0.94-0.99), respectively. As a comparison, outcomes from 25 studies on neoadjuvant chemotherapy were also pooled, with rates of CPR 0.08 (95% CI, 0.06-0.11), MPR 0.22 (95% CI, 0.19-0.26), and R0 resection 0.84 (95% CI, 0.80-0.87). Besides, the overall grade 3 or higher toxicity rates were 0.24 (95% CI 0.03-0.54) vs. 0.28 (95% CI 0.13-0.47) in ICI-based treatment and chemotherapy groups. Stratified by treatment strategies, ICI alone showed the lowest efficacy (CPR 0.07, 95% CI 0.02-0.19 and MPR 0.16, 95% CI 0.03-0.29). Addition of chemotherapy to ICI promoted the CPR (0.15, 95% CI 0.10-0.22) and MPR (0.36, 95% CI 0.22-0.50). Further addition of radiotherapy displayed the highest CPR (0.35, 95% CI 0.21-0.52) and MPR (0.74, 95% CI 0.54-0.93). Only four trials reported the outcomes of dMMR/MSI-H patients, with superior CPR (0.39, 95% CI 0.20-0.62) and MPR (0.82, 95% CI 0.82-1.00), while those of pMMR/MSS patients were 0.05 (95% CI 0.00-0.13) and 0.20 (95% CI 0.20-0.31) respectively, among which 2 trials used ICI only. Conclusions: Neoadjuvant ICI plus chemotherapy/radiotherapy, instead of ICI alone, has better pathological responses and R0 resection rates than chemotherapy. dMMR/MSI-H is a superior biomarker for neoadjuvant ICI therapy for resectable gastric cancer. The value or biomarker of immunotherapy in pMMR/MSS patients remains exploring.[Table: see text]
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/JCO.2022.40.4_suppl.291
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2022
    detail.hit.zdb_id: 2005181-5
    Location Call Number Limitation Availability
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    Online Resource
  • 2
    Online Resource
    Online Resource
    Optimization of treatment options for EGFR-mutant, stage III, unresectable NSCLC: A systematic review and meta-analysis.
    American Society of Clinical Oncology (ASCO) ; 2022
    In:  Journal of Clinical Oncology Vol. 40, No. 16_suppl ( 2022-06-01), p. 8548-8548
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 40, No. 16_suppl ( 2022-06-01), p. 8548-8548
    Abstract: 8548 Background: The PACIFIC study established a new treatment standard for Stage III unresectable NSCLC, but CRT followed by durvalumab failed to bring survival benefit to patients with EGFR mutations. EGFR-TKIs have been successful in the setting of first-line treatment of advanced NSCLC and postoperative adjuvant treatment of NSCLC. We explored whether locally advanced inoperable patients with EGFR mutations can benefit from EGFR-TKIs and the possibly best treatment regimen through meta-analysis. Methods: Studies involving unresectable stage III NSCLC with EGFR mutations published in PubMed, Embase, Cochrane, ClinicalTrials.gov, and abstracts of important international conferences (ASCO, ESMO, WCLC) from January 1, 2000 to September 30, 2021 were screened. An integrative analysis was performed using STATA (version 16.0), and a network meta-analysis based on a Bayesian framework was performed using R (version 3.6.1) for the studies with a control group. The primary endpoints were progression-free survival (PFS) and overall survival (OS). Results: A total of 3291 patients were identified in 17 studies, including 5 treatment measures including concurrent chemoradiotherapy (CRT), CRT followed by durvalumab (CRT+Durva), TKI monotherapy, radiotherapy combined with TKI (RT+TKI), and CRT combined with TKI (CRT+TKI). PFS with TKI-free treatments (CRT, CRT+Durva) was significantly shorter than TKI-containing ones (TKI, RT+TKI, CRT+TKI) (HR 2.17, 95%CI 1.47-3.19), but its advantage only translated into borderline OS benefit (1.27, 0.99-1.63). In detail, the PFS with TKI-containing measures, including TKI monotherapy (0.66, 0.50-0.87), RT+TKI (0.37, 0.28-0.50), or CRT+TKI (0.14, 0.03-0.75) were all significantly longer than CRT. Furthermore, the PFS with both RT+TKI (0.40, 0.21-0.76) and CRT+TKI (0.15, 0.03-0.74) were significantly longer than CRT+Durva, while no statistical difference existed in PFS between RT+TKI and CRT+TKI. However, TKI alone had significantly shorter PFS than RT+TKI (1.78, 1.17-2.67). There was no statistical difference in OS among all the treatments, with RT+TKI ranking first in the Bayesian ranking. The integrated analysis found that RT+TKI had the longest OS (65.7 months, 55.5-76.0 months) and PFS (21.8 months, 18.0-25.7 months) and the highest response rate (77.7%, 68.8%-86.6%). Severe neutropenia was the most common with CRT+TKI, while RT+TKI brought the highest incidences of radiation pneumonitis and esophagitis. Conclusions: For EGFR mutant Stage III unresectable NSCLC, RT and TKI are both essential. RT+TKI and CRT+TKI have significantly longer PFS than CRT±immunotherapy, and RT+TKI has OS benefit trends. Due to the lack of sufficient studies on CRT+TKI, it is urgent to conduct large randomized clinical trials to explore the optimal treatment for these patients.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/JCO.2022.40.16_suppl.8548
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2022
    detail.hit.zdb_id: 2005181-5
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
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