Efficacy and Safety of anti-GD2 monoclonal antibodies in the Management of High-Risk Neuroblastoma: A Systematic Review and Meta-Analysis
Notice bibliographique
Résumé
not-yet-known not-yet-known not-yet-known unknown Introduction: Neuroblastoma (NB) is a malignant tumor of the sympathetic nervous system that usually occurs in children below 5 years of age. High-risk Neuroblastoma (HR-NB) has a poor prognosis despite several treatment strategies. Anti-GD2 monoclonal antibodies (dinutuximab) have recently been added to the standard of care due to improved prognosis. We aimed to systematically assess the outcomes of HR-NB patients treated with anti-GD2 monoclonal antibodies and compare them with those on other treatment regimens. Methods: A comprehensive search strategy was used to search PubMed and the Cochrane Library for articles investigating the effect of dinutuximab on the outcomes of patients with HR-NB. Eligibility criteria included: 1) Diagnosis of HR-NB based on INSS and INRG staging, and MYCN status. 2) Dinutuximab or dinutuximab-beta as the primary agent used in intervention group. 3) Mean/median follow-up time greater than 6 months. Three investigators independently reviewed and extracted relevant articles. Any disagreements were addressed through consultation with other authors. Risk of bias assessment of the selected articles were conducted using the Cochrane Risk of Bias Tool for randomized controlled trials (RCTs) and Newcastle-Ottawa scale for observational studies. Review Manager Software was used to obtain and display the meta-analysis estimates in forest plots. Random effects models were used to calculate the mean difference and overall estimated effects for continuous variables. The main outcomes were all-cause mortality and 5-years event-free survival (5-year-EFS), while the secondary endpoints were the incidence of complete remission and adverse events associated with dinutuximab therapy. Results: Five studies, including two RCTs, two secondary analyses of clinical trials, and one retrospective cohort study, comprising 1,393 participants were included in the analysis. 686 of the patients received dinutuximab while the remaining 707 patients were assigned to other therapies as controls. Dinutuximab was associated with lower all-cause mortality as compared to control [Pooled RR, 0.41; 95% CI, 0.22-0.75, P=0.004, I 2=31%]. 5-year-EFS was also greater for patients treated with dinutuximab [MD: 0.12; 95% CI, 0.09-0.16; P<0.001, I 2=98%]. Dinutuximab was associated with a nonsignificant increase in the incidence of complete remission (Pooled RR, 3.63; 95% CI, 0.64-20.53, P=0.15, I2=70%). The common adverse events associated with dinutuximab therapy included fever, fluid retention, hypotension, hypoxia, and diarrhea. Keywords: dinutuximab, anti-GD2 monoclonal antibody, High-risk Neuroblastoma (HR-NB).
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,010 | 0,025 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,001 |
| Méta-épidémiologie (sens large) | 0,020 | 0,036 |
| Bibliométrie | 0,006 | 0,006 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,002 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».