Tzang Chih-Chen, Lee Yen-Wei, Lin Wei-Chen, Lin Long-Huei, Kang Yuan-Fu, Lin Ting-Yu, Wu Wei-Ting, Chang Ke-Vin
School of Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan, R.O.C.
School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan, R.O.C.
Oncol Lett. 2024 Sep 27;28(6):569. doi: 10.3892/ol.2024.14702. eCollection 2024 Dec.
Colorectal cancer (CRC) is challenging to treat due to its high metastatic rate. Recent strategies have focused on combining immune checkpoint inhibitors (ICIs) with other treatments. The aim of the present study was to conduct a network meta-analysis of randomized controlled trials (RCTs) to assess the efficacy and adverse effects of different ICI treatments for CRC. A literature search for RCTs was conducted using PubMed, the Cochrane Library, Embase, ClinicalTrials.gov and Web of Science databases, covering the period from the inception of each database until April 2024. A total of 12 RCTs involving 2,050 participants were selected for inclusion in the analysis. The network meta-analysis employed the MetaInsight tool to assess multiple endpoints. The criteria for study selection were based on the Population, Intervention, Comparison, Outcome and Studies framework as follows: i) Population, patients with CRC; ii) intervention, studies using ICI to treat CRC; iii) comparison, active comparators, including placebo; iv) outcome, overall survival, progression-free survival, objective response rate and adverse events; and v) study design, RCTs. The results of the analysis revealed that programmed cell death-ligand 1 (PD-L1) inhibitors significantly improved overall survival time [mean difference (MD), 2.28 months; 95% confidence interval (CI), 0.44 to 4.11], while programmed cell death protein 1 (PD-1) inhibitors exhibited a superior progression-free survival time (MD, 4.79 months; 95% CI, 3.18 to 6.40) compared with active comparators. However, none of the ICI treatments had significant differences in odds ratios for the objective response rate and adverse events compared with active comparators. These findings indicate that treatment with PD-L1 and PD-1 inhibitors improved the overall survival time and delayed disease progression in patients with CRC. These findings offer valuable insights for future research aimed at improving CRC patient outcomes.
由于结直肠癌（CRC）的高转移率，其治疗具有挑战性。最近的策略集中在将免疫检查点抑制剂（ICI）与其他治疗方法相结合。本研究的目的是对随机对照试验（RCT）进行网络荟萃分析，以评估不同ICI治疗CRC的疗效和不良反应。使用PubMed、Cochrane图书馆、Embase、ClinicalTrials.gov和Web of Science数据库对RCT进行文献检索，涵盖每个数据库创建至2024年4月的时间段。总共选择了12项涉及2050名参与者的RCT纳入分析。网络荟萃分析采用MetaInsight工具评估多个终点。研究选择标准基于人群、干预措施、对照、结局和研究框架，如下：i）人群，CRC患者；ii）干预措施，使用ICI治疗CRC的研究；iii）对照，活性对照，包括安慰剂；iv）结局，总生存期、无进展生存期、客观缓解率和不良事件；v）研究设计，RCT。分析结果显示，程序性细胞死亡配体1（PD-L1）抑制剂显著改善了总生存时间[平均差（MD），2.28个月；95%置信区间（CI），0.44至4.11]，而程序性细胞死亡蛋白1（PD-1）抑制剂与活性对照相比，无进展生存时间更优（MD，4.79个月；95%CI，3.18至6.40）。然而，与活性对照相比，ICI治疗在客观缓解率和不良事件的优势比方面均无显著差异。这些发现表明，PD-L1和PD-1抑制剂治疗可改善CRC患者的总生存时间并延缓疾病进展。这些发现为旨在改善CRC患者预后的未来研究提供了有价值的见解。
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