AUTHOR=Wang Cheng-Qiong , Huang Xiao-Rong , He Min , Zheng Xiao-Tian , Jiang Hong , Chen Qian , Fan Teng-Yan , Zhan Lin , Ling Juan , Feng Ji-Hong , Xiao Xue , Chen Xiao-Fan , Xiao Zheng 

TITLE=Intrapleural Administration With Rh-Endostatin and Chemical Irritants in the Control of Malignant Pleural Effusion: A Systematic Review and Meta-Analysis

JOURNAL=Frontiers in Oncology

VOLUME=Volume 11 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2021.649999

DOI=10.3389/fonc.2021.649999

ISSN=2234-943X

ABSTRACT=Introduction: A modified and recombinant human endostatin (Rh-endostatin) is often used in the control of malignant pleural effusion (MPE) through intrapleural infusion.
Objectives: To demonstrate the clinical response, survival and safety of Rh-endostatin plus chemical irritants, their optimal combinations, treatment threshold and optimal usage, we performed a new systematic review and meta-analysis.
Methodology: All randomized controlled trials (RCTs) were collected from Chinese and English electronic databases (from inception until August 2020). We pooled the data using a series of meta-analyses, and summarized the evidence quality following the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. 
Results: We included 75 RCTs recruiting 4678 patients, which reported six combinations for Rh-endostatin plus chemical irritants. All six combinations, only Rh-endostatin plus Cisplatin with enough trials might improve the complete response [2.29 (1.93, 2.71)] and quality of life [3.01 (2.49, 3.63)] and reduce the treatment failure [0.29 (0.25, 0.33)] and progressive disease [0.27 (0.22, 0.34)]. It might not increase the risk of adverse drug reactions. For patients with lung cancer, moderate to massive effusion, initial treatment, KPS score (≥ 60), or anticipated survival time (≥ 3 months), Rh-Endostatin (30 to 45 mg each time, once or twice a week for three to four times) plus Cisplatin (30 to 60 mg/m2) obtained a significant improvement in clinical response and a reduction of failure and progressive disease. Most results had good robustness and moderate quality.
Conclusions: Current evidence suggests that Rh-Endostatin with Cisplatin may be an optimal combination, which may improve the clinical response and reduce the failure and progressive disease with good safety. Rh-Endostatin (30 to 40 mg each time, once or twice a week for three to four times) with DDP (30 to 40 mg/m2) may be an optimal usage for achieving an ideal response.