Wan Xiaoyan, Huang Jiezheng, Huang Liu, Wang Yibin, Fu Yiyuan, Jin Xiaolong, Huang Zheng, Xiong Jian
Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Tianhe District, Guangzhou, 510623, Guangdong, China.
Discov Oncol. 2024 May 15;15(1):168. doi: 10.1007/s12672-024-01033-w.
Studies evaluating the effectiveness of immune checkpoint inhibitors (ICI) for endometrial cancer (EC) are limited. This study aimed to assess the efficacy of PD-1/PD-L1 inhibitors as monotherapy for EC by conducting a meta-analysis. The predictive significance of MMR status, a biomarker for ICI response, also required further investigation.
A systematic literature search was conducted in English databases until September 2023. The analysis included objective response rate (ORR), disease control rate (DCR), adverse events (AEs), and odds ratios (OR), along with their corresponding 95% confidence intervals (CI).
There were twelve trials totaling 685 individuals. PD-1/PD-L1 inhibitor monotherapy resulted in an ORR for 34% (95% CI = 24-44%) of the pooled EC patients. Subgroup analysis revealed a significantly higher ORR in dMMR EC (45%) compared to pMMR EC (8%), with an OR of 6.36 (95% CI = 3.64-11.13). The overall DCR was 42%, with dMMR EC at 51% and pMMR EC at 30% (OR = 2.61, 95% CI = 1.69-4.05). Grade three or higher adverse events (AEs) occurred in 15% of cases (95% CI = 9-24%) of the pooled incidence of AEs, which was 68% (95% CI = 65-72%).
This meta-analysis provides significant evidence for the effectiveness of PD-1/PD-L1 inhibitors as monotherapy for EC. Notably, dMMR EC patients demonstrated superior treatment efficacy with PD-1/PD-L1 inhibitor immunotherapy. Further research is required to explore subclassifications of EC based on dMMR molecular subtypes, enabling improved treatment strategies and outcomes for EC patients.
评估免疫检查点抑制剂（ICI）治疗子宫内膜癌（EC）有效性的研究有限。本研究旨在通过荟萃分析评估PD-1/PD-L1抑制剂作为EC单药治疗的疗效。错配修复（MMR）状态作为ICI反应的生物标志物的预测意义也需要进一步研究。
截至2023年9月，在英文数据库中进行了系统的文献检索。分析包括客观缓解率（ORR）、疾病控制率（DCR）、不良事件（AE）和比值比（OR），以及它们相应的95%置信区间（CI）。
共有12项试验，总计685例个体。PD-1/PD-L1抑制剂单药治疗使汇总的EC患者的ORR为34%（95%CI = 24-44%）。亚组分析显示，错配修复缺陷（dMMR）的EC患者的ORR（45%）显著高于错配修复正常（pMMR）的EC患者（8%），OR为6.36（95%CI = 3.64-11.13）。总体DCR为42%，dMMR的EC患者为51%，pMMR的EC患者为30%（OR = 2.61，95%CI = 1.69-4.05）。在汇总的AE发生率中，15%的病例发生了3级或更高等级的不良事件（95%CI = 9-24%），其中68%（95%CI = 65-72%）。
本荟萃分析为PD-1/PD-L1抑制剂作为EC单药治疗的有效性提供了重要证据。值得注意的是，dMMR的EC患者在PD-1/PD-L1抑制剂免疫治疗中表现出卓越的治疗效果。需要进一步研究探索基于dMMR分子亚型的EC亚分类，以改善EC患者的治疗策略和治疗结果。
