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 -