{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T06:05:03Z","timestamp":1789452303911,"version":"build-2803163510"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Extensive-stage small cell lung cancer (ES-SCLC) is highly aggressive with dismal prognosis, and platinum monochemotherapy offers modest long-term survival. Multiple first-line regimens integrating immunotherapy, anti-angiogenic agents and chemotherapy have been approved, yet direct head-to-head comparisons are scarce, and the optimal induction plus maintenance strategy remains undefined. In this study, a Bayesian network meta-analysis (NMA) was performed to hierarchically assess the efficacy and safety of available first-line regimens and identify balanced treatment strategies for ES-SCLC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Eligible phase III randomized controlled trials (RCTs) were identified by searching PubMed, Embase, the Cochrane Library, and Web of Science. Trials were included if they enrolled treatment-na\u00efve patients with ES-SCLC and reported at least one of the following outcomes: overall survival (OS), progression-free survival (PFS), or grade \u22653 treatment-related adverse events (TRAEs). NMA was implemented using the gemtc package in R. SUCRA values were calculated for treatment ranking, and subgroup analyses stratified by pharmacological mechanisms were conducted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Fourteen RCTs involving 8,945 patients across 18 regimens were included in the present analysis. These trials encompassed diverse combinations of mainstream immune checkpoint inhibitors, anti-angiogenic targeted agents, and chemotherapeutic agents. The atezolizumab + lurbinectedin + chemotherapy and benmelstobart + anlotinib + chemotherapy regimens showed the greatest potential for superior PFS and OS compared with chemotherapy alone. Subgroup analyses confirmed sustained efficacy benefits for PD-L1 inhibitor-based triple-combination strategies. The nivolumab + ipilimumab regimen was associated with the highest risk of severe toxicity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>PD-L1 inhibitor combined with platinum-based chemotherapy together with anti-angiogenic agents or lurbinectedin conferred optimal survival benefits, yet toxicity was correspondingly augmented. This study provides valuable insights into therapeutic drug selection for ES-SCLC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic Review Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420261402898<\/jats:ext-link>\n                      , identifier 420261402898.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphar.2026.1944817","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T05:36:20Z","timestamp":1789450580000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy and safety of first-line immunotherapy-related induction and maintenance therapy for extensive-stage small cell lung cancer: a systematic review and Bayesian network meta-analysis"],"prefix":"10.3389","volume":"17","author":[{"given":"Hong-Jing","family":"Yu","sequence":"first","affiliation":[{"name":"Department of Oncology, The First People\u2019s Hospital of Jiande","place":["Jiande, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun-Chen","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, The First People\u2019s Hospital of Jiande","place":["Jiande, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong-Sheng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of General Surgery, The First People\u2019s Hospital of Jiande","place":["Jiande, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhi","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, The First People\u2019s Hospital of Jiande","place":["Jiande, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qi","family":"Deng","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, The First People\u2019s Hospital of Jiande","place":["Jiande, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e014099","DOI":"10.1136\/jitc-2025-014099","article-title":"Immunological consequences of chemotherapy: implications for cancer immunotherapy","volume":"14","author":"Bishara","year":"2026","journal-title":"J. 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