Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China.
Department of Radiation Oncology, Anshan Cancer Hospital, Anshan, China.
PLoS One. 2021 Jun 4;16(6):e0252751. doi: 10.1371/journal.pone.0252751. eCollection 2021.
It remains unclear which treatment is the most effective for previously treated patients with advanced esophageal and esophagogastric junction (EGJ) cancer. We conducted a network meta-analysis to address this important issue.
PubMed, Embase, Cochrane Library, and Web of Science databases were searched for relevant phase II and III randomized controlled trials (RCTs). Overall survival (OS) was the primary outcome of interest, which was reported as hazard ratio (HR) and 95% confidence intervals (CIs).
Sixteen RCTs involving 3372 patients and evaluating 15 treatments were included in this network meta-analysis. Ramucirumab+chemotherapy (CT) (HR = 0.52, 95% CI: 0.35-0.77) and use of programmed death receptor 1 (PD-1) inhibitors, including camrelizumab (HR = 0.71, 95% CI: 0.57-0.88), sintilimab (HR = 0.70, 95% CI: 0.50-0.98), nivolumab (HR = 0.76, 95% CI: 0.62-0.94), and pembrolizumab (HR = 0.84, 95% CI: 0.72-0.98), conferred better OS than CT; however, this OS benefit was not observed for PD-L1 inhibitor (avelumab) and other target agents (trastuzumab, everolimus, gefitinib, and anlotinib). In subgroup analysis, ramucirumab+CT and pembrolizumab showed significant improvement in OS, when compared to CT, in esophageal/EGJ adenocarcinoma (AC) cases; moreover, all PD-1 inhibitors had significant OS advantage over CT in treating esophageal squamous cell carcinoma (SCC). Based on treatment ranking in terms of OS, ramucirumab+CT and camrelizumab were ranked the best treatments for patients with AC and SCC, respectively.
Ramucirumab+CT and PD-1 inhibitors were superior to CT for previously treated cases of advanced esophageal/EGJ cancer. Ramucirumab+CT seemed to be the most effective treatment in patients with esophageal/EGJ AC, while use of PD-1 inhibitors, especially camrelizumab, was likely to be the optimal treatment in patients with esophageal SCC.
对于既往治疗的晚期食管和食管胃交界（EGJ）癌患者，哪种治疗最有效仍不清楚。我们进行了一项网络荟萃分析来解决这个重要问题。
检索PubMed、Embase、Cochrane 图书馆和 Web of Science 数据库中的相关 II 期和 III 期随机对照试验（RCT）。总生存期（OS）是主要观察终点，以风险比（HR）和 95%置信区间（CI）报告。
纳入的 16 项 RCT 共纳入 3372 例患者，评估了 15 种治疗方法。与 CT 相比，ramucirumab+CT（HR=0.52，95%CI：0.35-0.77）和程序性死亡受体 1（PD-1）抑制剂的使用，包括 camrelizumab（HR=0.71，95%CI：0.57-0.88）、sintilimab（HR=0.70，95%CI：0.50-0.98）、nivolumab（HR=0.76，95%CI：0.62-0.94）和 pembrolizumab（HR=0.84，95%CI：0.72-0.98）可改善 OS；然而，PD-L1 抑制剂（avelumab）和其他靶向药物（曲妥珠单抗、依维莫司、吉非替尼和安罗替尼）并未观察到 OS 获益。亚组分析显示，与 CT 相比，ramucirumab+CT 和 pembrolizumab 可显著改善食管/EGJ 腺癌（AC）患者的 OS；此外，所有 PD-1 抑制剂在治疗食管鳞癌（SCC）方面均优于 CT。基于 OS 的治疗排序，ramucirumab+CT 和 camrelizumab 分别被评为 AC 和 SCC 患者的最佳治疗方法。
对于既往治疗的晚期食管/EGJ 癌患者，ramucirumab+CT 和 PD-1 抑制剂优于 CT。ramucirumab+CT 似乎是食管/EGJ AC 患者最有效的治疗方法，而 PD-1 抑制剂的使用，尤其是 camrelizumab，可能是食管 SCC 患者的最佳治疗方法。
