Oncolytic viruses (OVs) have shown prospects in advanced and metastatic cancer, and many clinical trials have been carried out. To compare OV therapies comprehensively and provide a categorized profile and ranking of efficacy and safety, a network meta-analysis was conducted. A total of 5948 studies were screened and 13 randomized controlled trials with 1939 patients, of whom 1106 patients received OV therapies, comparing four OVs (NTX-010, pexastimogene devacirepvec (Pexa-Vec), talimogene laherparepvec (T-VEC), and pelareorep) were included in a Bayesian network meta-analysis. Eligible studies reported at least one of the following clinical outcome measures: objective response rate (ORR) and grade ≥ 3 adverse events. Compared to systemic treatments alone, talimogene laherparepvec (T-VEC) (OR 7.00, 95% CI 1.90–26.00) and T-VEC plus systemic treatment (2.90, 0.80–11.00) showed better objective response rates (ORRs), whereas Pexa-Vec 1 * 109 pfu plus systemic treatment (0.91, 0.26–3.00) and pelareorep plus systemic treatment (1.10, 0.61–2.00) were found to be comparable. The grade ≥ 3 adverse event ranking of the treatments from worst to best was as follows: T-VEC (ranking probability 24%), Pexa-Vec 1 * 109 pfu plus systemic treatment (21%), Pexa-Vec 1 * 109 pfu (17%), T-VEC plus systemic treatment (13%), pelareorep plus systemic treatment (13%), systemic treatments (18%), Pexa-Vec 1 * 108 pfu (12%), and NTX-010 (20%). Compared with other oncolytic virus therapies for patients with advanced or metastatic cancer, T-VEC and T-VEC plus systemic treatment appear to provide the best ORR therapy in terms of monotherapy and combination respectively, but should be given with caution to grade ≥ 3 adverse events. Conversely, combining OVs with chemotherapy or target agents was demonstrated not to improve efficacy compared with chemotherapy or target agents alone. Combining OV therapies with immune-checkpoint inhibitors, instead of chemotherapy or target agents, tended to provide better ORRs without causing severe adverse events. This study will guide treatment choice and optimize future trial designs for investigations of advanced or metastatic cancer.

中文翻译：

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溶瘤病毒在晚期或转移性癌症中的疗效和安全性：网络荟萃分析

溶瘤病毒 (OVs) 在晚期和转移性癌症中显示出前景，并且已经进行了许多临床试验。为了全面比较 OV 疗法并提供分类概况和疗效和安全性排名，进行了网络荟萃分析。共筛选了 5948 项研究和 13 项随机对照试验，涉及 1939 名患者，其中 1106 名患者接受了 OV 治疗，比较了四种 OV（NTX-010、pexastimogene devacirepvec (Pexa-Vec)、talimogene laherparepvec (T-VEC) 和 pelareorep ) 被纳入贝叶斯网络荟萃分析。符合条件的研究报告了至少一项以下临床结果测量：客观缓解率 (ORR) 和 ≥ 3 级不良事件。与单独的全身治疗相比，talimogene laherparepvec (T-VEC) (OR 7.00, 95% CI 1.90–26. 00) 和 T-VEC 加全身治疗 (2.90, 0.80–11.00) 显示更好的客观缓解率 (ORR)，而 Pexa-Vec 1 * 109 pfu 加全身治疗 (0.91, 0.26–3.00) 和 pelareorep 加全身治疗 (1.10) , 0.61–2.00) 被发现是可比的。治疗的≥3级不良事件从最差到最好的排序如下：T-VEC（排序概率24%），Pexa-Vec 1 * 109 pfu加全身治疗（21%），Pexa-Vec 1 * 109 pfu (17%)、T-VEC 加全身治疗 (13%)、pelareorep 加全身治疗 (13%)、全身治疗 (18%)、Pexa-Vec 1 * 108 pfu (12%) 和 NTX-010 (20 %）。与其他针对晚期或转移性癌症患者的溶瘤病毒疗法相比，T-VEC 和 T-VEC 加全身治疗似乎分别在单药治疗和联合治疗方面提供了最佳的 ORR 治疗，但应谨慎给予≥3级不良事件。相反，与单独使用化疗或靶向药物相比，将 OVs 与化疗或靶向药物结合并不能提高疗效。将 OV 疗法与免疫检查点抑制剂相结合，而不是化学疗法或靶向药物，往往会提供更好的 ORR，而不会引起严重的不良事件。这项研究将指导治疗选择并优化未来的试验设计，以研究晚期或转移性癌症。倾向于提供更好的 ORR 而不会引起严重的不良事件。这项研究将指导治疗选择并优化未来的试验设计，以研究晚期或转移性癌症。倾向于提供更好的 ORR 而不会引起严重的不良事件。这项研究将指导治疗选择并优化未来的试验设计，以研究晚期或转移性癌症。