The clinical benefit of adding anlotinib to chemoradiothearpy in high-grade gliomas: a systematic review, meta-analysis, and specific analysis on glioblastoma

Anlotinib, a novel multi-target tyrosine kinase inhibitor, has shown promise in improving survival and managing associated complications. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of Anlotinib in patients with high-grade glioma, specifically glioblastoma (GBM). This study was conducted according to the PRISMA guidelines. A systematic search was conducted on PubMed, Embase, Web of Science, and Scopus up to 9 December 2024. The included studies were appraised and assessed for quality and potential bias and further statistical analyses were performed using STATA v.17. A total of 17 studies with 473 patients were recruited, which included 204 patients with GBM. The pooled analysis resulted in a 6-month OS of 67% (95% CI: 42-92%) and a 1-year OS equal to 50% (95% CI: 36-64%) from the Anlotinib treatment. Progression-free survival at 6 months was 61% (95% CI: 46-75%), and at 1 year was 27% (95% CI: 13-41%), also showing similar promising outcomes. The overall response rate (ORR) and disease control rate (DCR) were reported at 55% (95% CI: 44-67%) and 90% (95% CI: 87-94%), respectively. The sub-group analysis revealed that adding anlotinb to temozolomide (TMZ) and radiotherapy had superior outcomes regarding OS, PFS, and DCR. Moreover, the highest ORR and complete response rate were achieved by Anlotinib plus stereotactic radiosurgery. Anlotinib demonstrates considerable efficacy in extending survival and achieving disease control in high-grade glioma patients when added to radiotherapy and TMZ. These findings can support its inclusion in therapeutic regimens, warranting further investigation in large-scale randomized controlled trials.