Endostar (Rh-Endostatin) Enhanced the (Chemo)Radiosensitivity in Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis

Abstract

Previous clinical trials using Endostar, an anti-angiogenesis agent, in combination with chemoradiotherapy have indicated better survival and local control with no severe adverse events in non-small cell lung cancer (NSCLC). However, high-level evidence is lacking for routine use of Endostar concurrent with chemoradiotherapy in locally advanced NSCLC. This meta-analysis aimed to clarify the benefits of the addition of Endostar into (chemo)radiotherapy versus (chemo)radiotherapy alone for NSCLC.PubMed, Embase, Cochrane Central Register of Controlled Trials, Wanfang and Chinese National Knowledge Infrastructure (CNKI) were systematically screened from inception to August 2020 using the pre-specified terms. Prospective trials (evaluating or) comparing the efficacy of Endostar combined with (chemo)radiotherapy versus (chemo)radiotherapy for NSCLC were included. Primary endpoints were risk ratios (RRs) for objective response rate (ORR) and disease control rate (DCR). The secondary endpoints were RRs for overall survival (OS) and adverse events (AEs).Fifteen studies with 1036 patients were included for this meta-analysis. Endostar combined with (chemo)radiotherapy significantly improved ORR and DCR compared with (chemo)radiotherapy. The RRs of ORR and DCR for Endostar combined with concurrent chemoradiotherapy (CCRT) versus CCRT were 1.263 (95% CI: 1.137-1.403, P < 0.001) and 1.274 (95% CI: 1.124-1.444, P < 0.001), respectively. The RRs of ORR and DCR for Endostar combined with radiotherapy (RT) versus RT alone were 1.237 (95% CI: 1.009-1.518, P = 0.041) and 1.096 (95% CI: 1.005-1.196, P = 0.039), respectively. Endostar combined with CCRT significantly improved one-year OS rate compared with CCRT (RR = 1.113, 95% CI: 1.006-1.231, P = 0.038). Endostar combination treatments had similar incidences of main AEs compared with (chemo)radiotherapy (P > 0.05).Endostar combined with (chemo)radiotherapy is associated with significantly higher ORR and DCR than (chemo)radiotherapy with similar incidences of main AEs in NSCLC.