Abstract
INTRODUCTION: Temozolomide combined with radiotherapy has been widely recognized as the first-line treatment for glioblastoma. However, a standard treatment regimen for recurrent glioblastoma after treatment with temozolomide plus radiotherapy is lacking at present. This network meta-analysis aimed to assess and rank the therapeutic efficacy and safety of temozolomide plus radiotherapy combined with 11 other anti-cancer treatments in glioblastoma so as to provide valuable evidence for appropriate clinical decision-making. METHODS: Eligible studies investigating the efficacy and safety of temozolomide plus radiotherapy (standard treatment) compared to combination therapies were obtained by searching PubMed, Cochrane Library, and EMBASE. Outcomes included progression-free survival, overall survival, and grade 3-5 adverse events. RESULTS: A total of 16 studies were included in this meta-analysis. Except for autologous lymphoid effector cells specific against tumor, galunisertib, and interferon-β, other anti-cancer treatments used in combination with standard treatment resulted in a survival advantage over standard treatment alone. The combination of nimustine with standard treatment performed best in improving overall survival and progression-free survival and exhibited a favorable safety profile, making it the optimal treatment option for recurrent glioblastoma. CONCLUSION: After a comprehensive safety analysis, nimustine and lomustine were identified as effective drugs that could be combined with standard treatment. PROTOCOL REGISTRATION: www.crd.york.ac.uk/prospero identifier is CRD420251004329.