Efficacy and tolerability of first-line treatment regimens for extensive-stage small cell lung cancer - a grade-assessed network meta-analysis of randomized controlled trials

作者：Najah Q, Makhlouf HA, Osman ASA, Almosilhy NA, Abusalah MA, Abuhlaiga MA, Qutob IA, Abdelgawad HAH · 发表于：BMC cancer · 年份：2026 · DOI：10.1186/s12885-025-15439-4 · 被引用次数：86 · 研究领域：Lung Neoplasms、Small Cell Lung Carcinoma、Antineoplastic Combined Chemotherapy Protocols、Humans、Randomized Controlled Trials as Topic、Etoposide、Antibodies, Monoclonal, Humanized、Immunotherapy、Treatment Outcome、Neoplasm Staging

BACKGROUND: The treatment landscape for extensive-stage small-cell lung cancer (ES-SCLC) has advanced with the introduction of immunotherapy, targeted therapy, and novel chemotherapy combinations. A comprehensive evaluation of safety and efficacy across these treatments remains essential. This study aimed to compare the outcomes of all first-line treatment regimens for ES-SCLC. METHODS: A systematic literature search of PubMed, Scopus, and Web of Science databases was conducted from inception to June 2025 to identify randomized controlled trials evaluating first-line treatments for ES-SCLC (CRD42024543408). Etoposide plus platinum (EP), the standard regimen, was used as the reference treatment. Primary outcomes were overall survival (OS) and progression-free survival (PFS). Secondary outcomes included objective response rate (ORR) and adverse events (AEs). Hazard ratios (HR) were used for survival outcomes, and risk ratios (RR) for efficacy outcomes. A frequentist network meta-analysis was performed using the Netmeta R package (v2.9-0). Risk of bias was assessed using the Cochrane risk of bias tool v2, and certainty of evidence was evaluated according to GRADE guidelines. RESULTS: This analysis included 34 studies with 10,658 participants and 22 treatment regimes. For OS, immunotherapy-based regimens such as Serplulimab + EP (HR = 0.63, 95% CI: 0.44–0.90, p = 0.01), Atezolizumab + EP (HR = 0.70, 95% CI: 0.49–1.00, p = 0.05), and Durvalumab + EP (HR = 0.71, 95% CI: 0.53–0.96, ...