The following is a summary of “Efficacy and safety of first-line combination therapy versus monotherapy for vitreoretinal lymphoma: a systematic review and meta-analysis,” published in the November 2023 issue of Ophthalmology by Gao et al.
Researchers started a retrospective study to compare the efficacy and safety of first-line combination therapy, including intraocular methotrexate (ioMTX), high-dose intravenous methotrexate (HD-MTX), or local radiotherapy (RT), versus monotherapy, particularly Bruton’s tyrosine kinase inhibitors (BTKi), for the treatment of vitreoretinal lymphoma (VRL).
They performed a systematic review and meta-analysis on VRL patients (PubMed, Embase, and Scopus databases) until December 2022. In total, 24 studies (517 patients) were included, with survival data of 279 patients due to inconsistent units.
The results showed various treatment approaches in the combined treatment group, including ioMTX + chemotherapy (in 4 studies), RT + 2 studies in chemotherapy, 2 studies in ioMTX/HD-MTX based regimen, ioMTX + RT + 2 studies in chemotherapy, ioMTX + 2 studies in lenalidomide/BTKi, and a combination of multiple therapies (in 7 studies). The monotherapy group primarily received oral monotherapies like BTKi. The combination therapy demonstrated a higher overall response rate (ORR) and complete response rate (CRR) compared to monotherapy (ORR: 96% vs. 72%, CRR: 92% vs. 63%). Additionally, combination therapy led to a prolonged median progression-free survival (28.8 months vs. 13 months, p = 0.012). The combo therapy group had a 45% incidence of grade 3/4 toxicity, surpassing the monotherapy group’s 8%.
They concluded that combining therapy’s superiority in VRL treatment with BTKi monotherapy needs further investigation.
Source: bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-023-03226-3
