越来越多的证据表明，免疫疗法对患有脑转移（BM）的非小细胞肺癌（NSCLC）患者具有积极作用。然而，目前尚不清楚哪种类型的免疫疗法更有效。该网络荟萃分析 (NMA) 的目的是比较不同免疫疗法类型的疗效和安全性并确定最佳选择。检索了四个数据库（PubMed、Cochrane 图书馆数据库、Embase 和 Web of Science）和 ClinicalTrial.gov从开始到 2023 年 1 月 26 日。其中包括随机对照试验 (RCT)、前瞻性非随机试验或观察性研究，调查接受免疫疗法治疗的 BM 的 NSCLC 患者。使用 Cochrane 偏倚风险 (ROB) 工具和纽卡斯尔-渥太华量表 (NOS) 评估纳入研究的质量。使用频率随机效应 NMA 评估了免疫治疗对患有 BM 的 NSCLC 患者的疗效。该 NMA 纳入了 11 项研究，共 1560 次引用，涵盖 1437 名参与者。统计分析显示，pembrolizumab（SMD = 4.35，95% CI [2.21，6.60]）和nivolumab ipilimumab（SMD = 3.81，95% CI [1.21，6.40]）可以改善总生存（OS）。 Pembrolizumab（SMD = 3.32，95% CI [2.75，3.90]）在改善总体缓解率（ORR）方面表现出更好的效果。免疫疗法和化疗之间在不良事件（AE）方面没有观察到显着差异。我们的研究结果表明，派姆单抗是治疗患有 BM 的 NSCLC 患者最有希望的免疫疗法。 Nivolumab ipilimumab 可能是改善 OS 的替代选择。由于缺乏直接比较，未进行不一致性测试。此外，我们的 NMA 中观察到高度异质性。© 2024 作者。约翰·威利出版的《临床呼吸杂志》

Growing evidence suggests that immunotherapy has a positive effect on non-small cell lung cancer (NSCLC) patients with brain metastases (BMs). However, it remains unclear which type of immunotherapy is more efficient. The aim of this network meta-analysis (NMA) was to compare the efficacy and safety of different immunotherapy types and determine the optimal option.Four databases (PubMed, Cochrane Library databases, Embase, and Web of Science) and ClinicalTrial.gov were searched from inception until January 26, 2023. Randomized controlled trials (RCTs), prospective nonrandomized trials, or observational studies investigating NSCLC patients with BMs treated by immunotherapy were included. The quality of the included studies was evaluated using the Cochrane risk of bias (ROB) tool and the Newcastle-Ottawa Scale (NOS). The efficacy of immunotherapy on NSCLC patients with BMs was evaluated using frequentist random-effects NMA.Eleven studies from 1560 citations, encompassing 1437 participants, were included in this NMA. Statistical analysis showed that pembrolizumab (SMD = 4.35, 95% CI [2.21, 6.60]) and nivolumab+ipilimumab (SMD = 3.81, 95% CI [1.21, 6.40]) could improve overall survival (OS). Pembrolizumab (SMD = 3.32, 95% CI [2.75, 3.90]) demonstrated better effects in improving the overall response rate (ORR). No significant difference in adverse event (AE) was observed between immunotherapy and chemotherapy.Our findings indicated that pembrolizumab was the most promising immunotherapy for NSCLC patients with BMs. Nivolumab+ipilimumab might be an alternative choice to improve OS.Inconsistency tests were not performed because of the scarcity of direct comparison. Besides, high heterogeneity was observed in our NMA.© 2024 The Author(s). The Clinical Respiratory Journal published by John Wiley & Sons Ltd.