Efficacy Comparison of Neoadjuvant Short-Course and Long-Course Radiotherapy Regimens With or Without Immunotherapy for Locally Advanced pMMR Rectal Cancer: A Systematic Review and Network Meta-Analysis - Summary - MDSpire
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Efficacy Comparison of Neoadjuvant Short-Course and Long-Course Radiotherapy Regimens With or Without Immunotherapy for Locally Advanced pMMR Rectal Cancer: A Systematic Review and Network Meta-Analysis
To indirectly compare and rank the efficacy of four neoadjuvant strategies (SCRT, SCRT + ICIs, LCRT, LCRT + ICIs) for achieving a curative-intent response in patients with proficient mismatch repair (pMMR) locally advanced rectal cancer (LARC).
Key Findings:
SCRT-based regimens may achieve non-inferior or superior pCR (pathologic complete response) rates compared to LCRT-based regimens.
The addition of PD-1 inhibitors to both SCRT and LCRT regimens significantly improves pCR rates.
No direct comparative evidence exists between SCRT + ICIs and LCRT + ICIs.
Interpretation:
The findings suggest that both SCRT and LCRT regimens, when combined with immunotherapy, can enhance treatment efficacy in pMMR LARC, but the optimal regimen remains unclear due to the lack of direct comparisons, which has significant implications for clinical practice.
Limitations:
Absence of head-to-head trials comparing SCRT + ICIs and LCRT + ICIs.
Potential biases in included studies due to varying methodologies, which may affect the reliability of the findings.
Conclusion:
This NMA provides actionable evidence for clinical decision-making regarding neoadjuvant strategies in pMMR LARC, highlighting the critical need for further direct comparative trials to establish the optimal treatment regimen.
