The efficacy and safety of anti-angiogenic drugs combined with chemotherapy in treating malignant pleural mesothelioma: An updated systematic review and meta-analysis

doi:10.3969/j.issn.1004-583X.2025.04.002

Abstract

Abstract:

Objective This systematic review and meta-analysis aims to assess the efficacy and safety of anti-angiogenic drugs in treating malignant pleural mesothelioma (MPM). Methods Articles reporting the efficacy and safety of anti-angiogenic drugs in treating MPM from database inception through November 2024 were searched in the PubMed, Cochrane, and CNKI. Meta-analysis was performed using RevMan 5.4. Results Six high-quality randomized clinical trials (RCTs) involving 1, 632 patients were enrolled, including 814 in the experimental group (angiogenesis inhibitors+chemotherapy) and 818 in the control group (placebo+chemotherapy or chemotherapy alone). Compared with the control group, patients in the experimental group showed superior long-term survival (HR=0.83, 95%CI: 0.73-0.96, P=0.009) and short-term efficacy (HR=0.77, 95%CI: 0.64-0.93, P=0.007). The incidence of adverse reactions remained within acceptable limits (RR=1.21, 95%CI: 1.12-1.30, P<0.00001). Conclusion Anti-angiogenetic drugs combined with chemotherapy provides significant clinical benefits over placebo plus chemotherapy or chemotherapy alone in MPM treatment, with manageable toxicity profiles.

Key words: mesothelioma, malignant, angiogenesis inhibitors, efficacy, safety

CLC Number:

R730.262.7

Tang Xu, Zuo Zhuang, Yang Kai, Zhang Zhiyuan, Wang Qi, Dong Xinchun, Gou Yunjiu. The efficacy and safety of anti-angiogenic drugs combined with chemotherapy in treating malignant pleural mesothelioma: An updated systematic review and meta-analysis[J]. Clinical Focus, 2025, 40(4): 304-312.

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URL: https://lchc.magtechjournal.com/EN/10.3969/j.issn.1004-583X.2025.04.002

https://lchc.magtechjournal.com/EN/Y2025/V40/I4/304

Figures/Tables 13

Fig. 1 Flowchart of the retrieval process

Tab. 1 Basic information of the included literature

第一作者	时间	例数^*	治疗方式		HR(95%CI)		三级不良反应发生率
第一作者	时间	例数^*	对照组	研究组	PFS	OS	对照组	研究组
Zalcman^[6]	2016	223/225	AP	贝伐珠单抗+AP	0.61(0.50~0.75)	0.77(0.62~0.95)	139/224	158/222
Gregorc^[14]	2018	193/193	安慰剂+最佳治疗	NGF-hTNF+最佳治疗	0.95(0.78~1.17)	0.94(0.75~1.18)	118/193	136/193
Scagliotti^[15]	2019	229/229	安慰剂+AP	尼达尼布+AP	1.01(0.79~1.30)	1.12(0.79~1.58)	127/228	153/227
Tsao^[16]	2019	45/47	安慰剂+AP	西地尼布+AP	0.70(0.46~1.09)	0.88(0.57~1.35)	27/47	31/45
Pinto^[17]	2021	80/81	吉西他滨加安慰剂	吉西他滨+ramucirumab	0.79(0.66~0.94)	0.71(0.59~0.85)	24/81	35/80
Grosso^[18]	2017	44/43	尼达尼布	培美曲塞+顺铂+尼达尼布	0.54(0.33~0.87)	0.77(0.46~1.29)	22/43	35/44

Fig. 2 Proportion of risk of bias

Fig. 3 Summary of risk of bias

Fig. 4 Forest plot of the meta-analysis for overall survival

Fig. 5 Forest map of meta-analysis for progression-free survival

Fig. 6 Forest map of meta-analysis of grade 3 to 5 adverse reactions

Fig. 7 Forest map of Meta-analysis of overall survival in the epithelioid subgroup

Fig. 8 Forest map of meta-analysis of total survival in the non-epithelioid subgroups

Fig. 9 Forest map of meta-analysis of progression-free survival in the epithelioid subgroup

Fig. 10 Forest map of meta-analysis of progression-free survival in non-epithelioid subgroups

Fig. 11 Forest map of meta-analysis of grade 3 to 5 adverse reactions in groups

Fig. 12 Funnel polt of publication bias

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