Department of Oncology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China.
J Immunother. 2022 Jun 1;45(5):243-253. doi: 10.1097/CJI.0000000000000420. Epub 2022 Apr 26.
Immunotherapy combined with chemotherapy has recently changed the first-line treatment of several cancers. We performed a systematic review and meta-analysis to assess the efficacy and safety of programmed cell death 1 (PD-1) inhibitor plus chemotherapy as a first-line treatment for advanced esophageal cancer. Data were collected from eligible studies searched from PubMed, Web of Science, Cochrane Library, Embase, and meeting abstracts. The pooled hazard ratios (HRs) for overall survival (OS) and progression-free survival (PFS) and the pooled odds ratios (ORs) for objective response rate and treatment-related adverse events (TRAEs) were estimated to assess the efficacy and safety of PD-1 inhibitor plus chemotherapy versus chemotherapy. We performed several subgroup analyses to explore the variables affecting immunotherapy efficacy in esophageal cancer. The 5-point Jadad scoring system, the bias risk assessment and sensitivity analyses were used to evaluate the quality of the meta-analysis. Compared with the chemotherapy group, the OS (HR=0.70; P<0.01) and PFS (HR=0.62; P<0.01) were significantly longer and the objective response rate (OR=2.07; P<0.01) was significantly higher in the PD-1 inhibitor plus chemotherapy group. An OS benefit was observed in patients regardless of histology or programmed cell death 1 ligand 1 combined positive score. OS and PFS were generally consistent across subgroups by clinical features. In safety analyses, PD-1 inhibitor plus chemotherapy had a significantly higher incidence of TRAEs (OR=1.85; P<0.01), but there was no significant difference in grade 3 or higher TRAEs (OR=1.24; P=0.05). Compared with chemotherapy, PD-1 inhibitor plus chemotherapy improves antitumor activity and controllable adverse events in the first-line treatment of advanced esophageal cancer.
免疫疗法联合化疗最近改变了几种癌症的一线治疗方法。我们进行了系统评价和荟萃分析，以评估程序性细胞死亡 1（PD-1）抑制剂联合化疗作为晚期食管癌一线治疗的疗效和安全性。从 PubMed、Web of Science、Cochrane 图书馆、Embase 和会议摘要中搜索到的合格研究中收集数据。汇总的总生存期（OS）和无进展生存期（PFS）的风险比（HR）以及客观缓解率（OR）和治疗相关不良反应（TRAEs）的汇总比值比（OR）用于评估 PD-1 抑制剂联合化疗与化疗的疗效和安全性。我们进行了几项亚组分析，以探讨影响食管癌免疫治疗疗效的变量。使用 5 分 Jadad 评分系统、偏倚风险评估和敏感性分析来评估荟萃分析的质量。与化疗组相比，PD-1 抑制剂联合化疗组的 OS（HR=0.70；P<0.01）和 PFS（HR=0.62；P<0.01）显著延长，客观缓解率（OR=2.07；P<0.01）显著提高。无论组织学或程序性细胞死亡 1 配体 1 联合阳性评分如何，PD-1 抑制剂联合化疗均观察到 OS 获益。OS 和 PFS 在按临床特征进行的亚组分析中总体一致。在安全性分析中，PD-1 抑制剂联合化疗的 TRAEs 发生率显著升高（OR=1.85；P<0.01），但 3 级或更高 TRAEs 发生率无显著差异（OR=1.24；P=0.05）。与化疗相比，PD-1 抑制剂联合化疗可提高晚期食管癌一线治疗的抗肿瘤活性和可控不良反应。
