The efficacy of Endostar combined with platinum pleural infusion for malignant pleural effusion in tumor patients is significantly better than that of monotherapy, but the economy is lower: a systematic review, network meta-analysis and cost-effectiveness analysis

Abstract

Background: Endostar and platinum were widely used in the treatment of malignant pleural effusion (MPE), but there was no unified conclusion on which scheme is the best. The aim of this study was to systematically evaluate the efficacy and cost-effectiveness of Endostar, cisplatin, lobaplatin, Endostar combined with cisplatin, and Endostar combined with lobaplatin in the treatment of MPE so as to provide a reference for clinical treatment. Methods: A comprehensive literature search was performed of sources on PubMed, Web of Science, and other databases published up to and including November 23, 2021, and screened out randomized controlled trial (RCT) concerning the efficacy of 5 interventions of pleural perfusion for MPE. The CochraneCollaboration tool was used for assessing the risk of bias, and a network meta-analysis was performed with Addis software based on the Bayesian framework. A decision tree model was used to complete a costeffectiveness analysis that was based on the direct medical costs and the probabilities were determined from the network meta-analysis. The one-way sensitivity analysis was presented with a tornado chart. In the probabilistic sensitivity analysis, the cost-effectiveness acceptability curve was obtained after Monte Carlo simulation.Results: A total of 55 studies were included, comprising 3,379 total patients, excluding the unclear part, we evaluated as low risk of bias. According to the network meta-analysis, Endostar combined with lobaplatin had the highest effectiveness, followed by Endostar combined with cisplatin, Endostar, cisplatin, and lobaplatin.In the incremental cost-effectiveness ratio (ICER) analysis, lobaplatin and Endostar were excluded as inferior schemes. With cisplatin as the comparison, the ICER of Endostar combined with cisplatin was yuan renminbi ¥22,648.31. With Endostar combined with cisplatin as the comparison, the ICER of Endostar combined with lobaplatin was ¥236,502.67. The results of sensitivity analysis and cost-effectiveness analysis were basically consistent.Conclusions: Endostar combined with lobaplatin had the highest effectiveness, but its ICER was relatively too high to be acceptable. Therefore, cisplatin alone and Endostar combined with cisplatin were more costeffective, and clinicians can choose the optimal treatment scheme based on the willingness to pay (WTP) of different patients with comprehensive consideration of effectiveness and economy.

Malignant Pleural Effusions in the Era of Immunotherapy and Antiangiogenic Therapy

“…Overall, Endostar is a safe and efficacious drug to use in combination with pemetrexed and cisplatin for advance NSCLC complicated by MPE, but primarily a drug that is used within China rather than the United States. 32,67,[69][70][71]…”

Case report: Envafolimab combined with Endostar in the treatment of advanced non-small cell lung cancer with malignant pleural effusion

“…Endostar is an anti-angiogenic agent developed in China that has been recommended as a first-line treatment option for NSCLC ( 10 ). In patients with NSCLC accompanied by MPE, Endostar can significantly improve the control rate of MPE and reduce its recurrence rate ( 11 ). Envafolimab, a novel subcutaneous single-domain anti-PD-L1 antibody, has been approved for treating microsatellite instability-high (MSI-H) or DNA-mismatch repair (dMMR) solid tumors in China.…”

Efficacy and Safety of Chinese Herbal Injection Thoracic Perfusion combined with Cisplatin chemotherapy for Lung Cancer Malignant Pleural Effusion: A Systematic Review and Meta-Analysis

“…Currently, management options for MPE includes chest tube drainage and systematic chemotherapy to achieve symptomatic relief and controlling the primary malignancies. Thoracic perfusion of chemotherapeutic is an effective method for the treatment of MPE, and thoracic perfusion of cisplatin has good pharmacodynamics [4,5] , high economic practicability [6] . However, the side effects of cisplatin, such as gastrointestinal reactions and hepatorenal toxicity, cannot be ignored, and will affect the quality of life of patients to a certain extent [7] .…”