Yan Chunyan, Cao Wenxiu, Li Jianghua, Zhang Lei, Diao Ruigang
Department of Pharmacy, Yantai Yuhuangding Hospital, Yantai, China.
Yantai Municipal Government Hospital, Yantai, China.
Front Pharmacol. 2024 Jul 18;15:1408458. doi: 10.3389/fphar.2024.1408458. eCollection 2024.
Recently, a sum of trials of programmed cell death-1 (PD-1) inhibitors combined with chemotherapy have shown excellent efficacy compared to chemotherapy alone in patients with previously untreated, advanced esophageal squamous cell carcinoma (ESCC). However, there is no head-to-head comparison and consensus on which immunotherapy regimen results in better survival outcomes. This study aimed to evaluate the survival efficacy of various PD-1 inhibitor-based therapies in the first-line treatments for patients with advanced ESCC.
Data collected prior to 31 July 2023 were searched in the PubMed, Cochrane Library, Embase, Medline, and Web of Science databases. Overall survival (OS) and progression-free survival curves were pooled using the MetaSurv package. Survival data were compared by reconstructed individual patient data.
A total of 4,162 patients and seven randomized controlled trials were included. After synthesizing, PD-1 inhibitors prolonged median OS from 11.3 months (95% CI (confidence interval) 10.7-11.7) to 15.6 months (95% CI 14.7-16.3). Based on reconstructed patient-level data, the toripalimab, tislelizumab, and sintilimab group achieved the longest OS, whereas the sintilimab and tislelizumab group had the lowest risk of recurrence than other treatments. In patients with a combined positive score of ≥10, sintilimab had better OS efficacy than pembrolizumab (HR: 0.71, 95% CI: 0.52-0.96). In terms of tumor proportion score of ≥1%, camrelizumab, nivolumab, and toripalimab showed proximate survival benefits in both OS and progression-free survival.
PD-1 inhibitor combined with chemotherapy significantly improved the survival time of patients with advanced ESCC. Toripalimab, tislelizumab, and sintilimab plus chemotherapy showed the best OS benefit. Longer progression-free benefits might be generated from adding tislelizumab and sintilimab to chemotherapy. Sintilimab was strongly recommended for patients with high programmed cell death-ligand 1 abundance.
[https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42024501086].
最近，一系列程序性细胞死亡蛋白1（PD-1）抑制剂联合化疗的试验表明，与单纯化疗相比，其在先前未接受过治疗的晚期食管鳞状细胞癌（ESCC）患者中显示出优异的疗效。然而，对于哪种免疫治疗方案能带来更好的生存结果，尚无直接比较和共识。本研究旨在评估各种基于PD-1抑制剂的疗法在晚期ESCC患者一线治疗中的生存疗效。
检索了截至2023年7月31日在PubMed、Cochrane图书馆、Embase、Medline和Web of Science数据库中收集的数据。使用MetaSurv软件包汇总总生存（OS）和无进展生存曲线。通过重建个体患者数据比较生存数据。
共纳入4162例患者和7项随机对照试验。综合分析后，PD-1抑制剂将中位OS从11.3个月（95%CI（置信区间）10.7-11.7）延长至15.6个月（95%CI 14.7-16.3）。基于重建的患者水平数据，托瑞帕利单抗、替雷利珠单抗和信迪利单抗组的OS最长，而信迪利单抗和替雷利珠单抗组的复发风险低于其他治疗。在联合阳性评分≥10的患者中，信迪利单抗的OS疗效优于帕博利珠单抗（HR：0.71，95%CI：0.52-0.96）。在肿瘤比例评分≥1%的患者中，卡瑞利珠单抗、纳武利尤单抗和托瑞帕利单抗在OS和无进展生存方面显示出相近的生存获益。
PD-1抑制剂联合化疗显著改善了晚期ESCC患者的生存时间。托瑞帕利单抗、替雷利珠单抗和信迪利单抗联合化疗显示出最佳的OS获益。在化疗中加入替雷利珠单抗和信迪利单抗可能会带来更长的无进展获益。强烈推荐将信迪利单抗用于程序性细胞死亡配体1高表达的患者。
