| Background:Malignant glioma is the most common intracranial malignant tumor with the highest mortality.At present,the treatment methods of malignant glioma mainly include surgical treatment,radiotherapy and chemotherapy which with poor treatment effect,the survival of most patients has not been significantly improved,especially the 5-year survival rate of Grade IV glioma patients with the highest degree of malignancy is less than 5%.Therefore,it is urgent to find a more effective treatment for glioma.Objective:The efficacy and safety of immunotherapy in glioma were evaluated by systematic review and meta-analysis.At the same time,the differences in efficacy of different immunotherapy in gliomas were explored,and whether the combination of immunotherapy and different types of standard of care could improve efficacy or reduce adverse effects.Method:The Cochrane Library,Pub Med,MEDLINE,and the Web of Science Core Collection were systematically searched.Retrieved hits were screened for inclusion in 2,317 articles.We extracted hazard ratio of overall survival(OS)and progressionfree survival(PFS)for examining the efficacy of immunotherapy.And we calculated adverse events for assessing the safety of immunotherapy.This study was registered with PROSPERO,number CRD42019112356.Result:Finally,11 studies were included,including 2 historical controlled studies and 9randomized controlled studies.A total of 1,271 patients,of which 524 patients received a combination of immunotherapy and conventional treatment,and 747 patients received conventional treatment.1.HGG patients receiving immunotherapy can extend the overall survival(HR=0.74,95%CI(0.56-0.99),Z=-2.00,p=0.0458)and progression-free survival(HR=0.67,95%CI)(0.45-0.99),Z=-1.99,p=0.0466),certain adverse reactions occurred(proportion=0.0773,95% CI 0.0589-0.1014).Compared with conventional treatment,immunotherapy combined with conventional treatment has a higher incidence of adverse reactions(RR=1.67,95%CI 1.28-2.19,Z=3.76,p=0.0002<0.05)(proportion=0.08,95% CI 0.06-0.10).2.HGG patients can prolong the overall survival(HR=0.60,95%CI(0.45-0.80),Z=-3.53,p=0.0004)by receiving multiple courses/multipoint injections/injection of small-volume viral therapy(VT)treatment,but could not prolong progression-free survival(HR=0.52,95%CI(0.22-1.22),Z=-1.50,p=0.1343).Compared with conventional treatment,VT treatment combined with conventional treatment has certain adverse reactions(RR=1.45,95%CI(1.18-1.79),Z=3.50,p=0.0005)(proportion=0.03,95% CI 0.02-0.05).Compared with a single course of treatment,the incidence of adverse reactions of multiple courses of viral therapy was significantly reduced,and there were no obvious side effects(RR=1.00,95%CI(0.66-1.53),Z=0,p>0.05).3.HGG patients can prolong the overall survival(HR=0.38,95% CI 0.21-0.68;Z=-3.23,p=0.0012)by receiving dendritic cell vaccine(DC)treatment,but the progression-free period cannot be prolonged(HR=0.60,95% CI 0.35-1.0345;Z=-1.84,p=0.0661).Moderate adverse events occurred in patients with DC treatment combined with conventional treatment,and the incidence of adverse events is about18%(proportion=0.18,95% CI 0.10-0.34).4.HGG patients cannot prolong the overall survival(HR=0.69,95% CI 0.50-0.96;Z=-2.23,p=0.0256)by receiving immunopotentiator(IP)treatment,nor canthey extend the progression-free survival(HR=1.20,95%CI(0.75-1.92),Z=0.76,p=0.449).Compared with conventional treatment,IP treatment combined with conventional treatment has serious adverse events(RR=2.0291,95%CI(1.2700-3.2418),Z=2.96,p=0.0031)(proportion=0.18,95% CI 0.13-0.25).Conclusion:1.The treatment of dendritic vaccine significantly improves the overall survival of HGG patients.2.Viral therapy can further optimize and improve the treatment method by using multiple treatment courses/multipoint injections/smaller injection volume,and further improve its curative effect on HGG patients.3.Immunotherapy has certain toxic and side effects,but compared with dendritic vaccines and immunopotentiators,the incidence of adverse events of viral therapy is much lower. |
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