TY - JOUR
T1 - Somatostatin analogues in treatment-refractory meningioma
T2 - a systematic review with meta-analysis of individual patient data
AU - Jensen, Lasse Rehné
AU - Maier, Andrea Daniela
AU - Lomstein, Atle
AU - Graillon, Thomas
AU - Hrachova, Maya
AU - Bota, Daniela
AU - Ruiz-Patiño, Alejandro
AU - Arrieta, Oscar
AU - Cardona, Andrés Felipe
AU - Rudà, Roberta
AU - Furtner, Julia
AU - Roeckle, Ulrich
AU - Clement, Paul
AU - Preusser, Matthias
AU - Scheie, David
AU - Broholm, Helle
AU - Kristensen, Bjarne Winther
AU - Skjøth-Rasmussen, Jane
AU - Ziebell, Morten
AU - Munch, Tina Nørgaard
AU - Fugleholm, Kåre
AU - Walter, Martin A.
AU - Mathiesen, Tiit
AU - Mirian, Christian
N1 - Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2022
Y1 - 2022
N2 - Treatment-refractory meningiomas have a dismal prognosis and limited treatment options. Meningiomas express high-densities of somatostatin receptors (SSTR), thus potentially susceptible to antitumorigenic effects of somatostatin analogues (SSA). Evidence for SSA in meningiomas is scarce, and it is unclear if published literature would either (1) support wider use of SSA, if (2) more evidence is desirable, or if (3) available evidence is sufficient to discard SSA. We addressed the need for more evidence with a systematic review and meta-analysis. We performed an individual patient data (IPD) meta-analysis. Main outcomes were toxicity, best radiological response, progression-free survival, and overall survival. We applied multivariable logistic regression models to estimate the effect of SSA on the probability of obtaining radiological disease control. The predictive performance was evaluated using area under the curve and Brier scores. We included 16 studies and compiled IPD from 8/9 of all previous cohorts. Quality of evidence was overall ranked “very low.” Stable disease was reported in 58% of patients as best radiological response. Per 100 mg increase in total SSA dosage, the odds ratios for obtaining radiological disease control was 1.42 (1.11 to 1.81, P = 0.005) and 1.44 (1.00 to 2.08, P = 0.05) for patients treated with SSA as monodrug therapy vs SSA in combination with everolimus, respectively. Low quality of evidence impeded exact quantification of treatment efficacy, and the association between response and treatment may represent reverse causality. Yet, the SSA treatment was well tolerated, and beneficial effect cannot be disqualified. A prospective trial without bias from inconsistent study designs is warranted to assess SSA therapy for well-defined meningioma subgroups.
AB - Treatment-refractory meningiomas have a dismal prognosis and limited treatment options. Meningiomas express high-densities of somatostatin receptors (SSTR), thus potentially susceptible to antitumorigenic effects of somatostatin analogues (SSA). Evidence for SSA in meningiomas is scarce, and it is unclear if published literature would either (1) support wider use of SSA, if (2) more evidence is desirable, or if (3) available evidence is sufficient to discard SSA. We addressed the need for more evidence with a systematic review and meta-analysis. We performed an individual patient data (IPD) meta-analysis. Main outcomes were toxicity, best radiological response, progression-free survival, and overall survival. We applied multivariable logistic regression models to estimate the effect of SSA on the probability of obtaining radiological disease control. The predictive performance was evaluated using area under the curve and Brier scores. We included 16 studies and compiled IPD from 8/9 of all previous cohorts. Quality of evidence was overall ranked “very low.” Stable disease was reported in 58% of patients as best radiological response. Per 100 mg increase in total SSA dosage, the odds ratios for obtaining radiological disease control was 1.42 (1.11 to 1.81, P = 0.005) and 1.44 (1.00 to 2.08, P = 0.05) for patients treated with SSA as monodrug therapy vs SSA in combination with everolimus, respectively. Low quality of evidence impeded exact quantification of treatment efficacy, and the association between response and treatment may represent reverse causality. Yet, the SSA treatment was well tolerated, and beneficial effect cannot be disqualified. A prospective trial without bias from inconsistent study designs is warranted to assess SSA therapy for well-defined meningioma subgroups.
KW - Meningioma
KW - Meta-analysis
KW - Neuro-oncology
KW - Progressive
KW - Treatment-refractory
U2 - 10.1007/s10143-022-01849-6
DO - 10.1007/s10143-022-01849-6
M3 - Review
C2 - 35984552
AN - SCOPUS:85136483053
VL - 45
SP - 3067
EP - 3081
JO - Neurosurgical Review
JF - Neurosurgical Review
SN - 0344-5607
ER -