Wang Chenglong, Cai Tongze, Wei Jiangcun, Huang Ying, Xiao Lin, Li Tong, Qin Zujie
Guangxi International Zhuang Medicine Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China.
Graduate School, Guangxi University of Chinese Medicine, Nanning, China.
Front Oncol. 2024 Nov 12;14:1369848. doi: 10.3389/fonc.2024.1369848. eCollection 2024.
We performed a network meta-analysis of phase III trials to compare the efficacy and safety of first-line regimens for patients with advanced esophageal squamous cell carcinoma (ESCC).
A systematic review and Bayesian network meta-analysis were conducted by retrieving relevant literature from PubMed, Embase, the Cochrane Library, and the Web of Science. We included published sources of randomized clinical trials comparing immunotherapy combinations for treating advanced ESCC.
We analyzed seven studies involving eight immunotherapy combinations and 4688 patients. For patients without programmed death-ligand 1 (PD-L1) selection, it was found that the combination of toripalimab and chemotherapy provided better overall survival than chemotherapy alone (hazard ratio = 0.58, 95% confidence interval (CI) 0.43-0.78). Compared with chemotherapy alone, Sintilimab or camrelizumab plus chemotherapy seemed to achieve the best progression-free survival (hazard ratio = 0.56, 95% CI 0.46-0.68). Nivolumab plus chemotherapy appeared to provide the best objective response rate, with significant differences versus chemotherapy alone (odds ratio = 0.49, 95% CI 0.38-0.64). Nivolumab plus ipilimumab resulted in a relatively lower incidence of adverse events of grade ≥3 than other regimens.
The combination of immune checkpoint inhibitors (ICIs) with chemotherapy provided a high probability of more effective treatment in comparison with chemotherapy alone for patients with advanced ESCC. Toripalimab and sintilimab plus chemotherapy were ranked as providing the highest OS and PFS benefit in the first-line setting, respectively.
我们对III期试验进行了网络荟萃分析，以比较晚期食管鳞状细胞癌（ESCC）患者一线治疗方案的疗效和安全性。
通过检索PubMed、Embase、Cochrane图书馆和科学网的相关文献，进行了系统评价和贝叶斯网络荟萃分析。我们纳入了比较免疫疗法联合治疗晚期ESCC的随机临床试验的已发表资料。
我们分析了7项研究，涉及8种免疫疗法联合方案和4688例患者。对于未进行程序性死亡配体1（PD-L1）选择的患者，发现特瑞普利单抗与化疗联合使用比单纯化疗具有更好的总生存期（风险比=0.58，95%置信区间（CI）0.43-0.78）。与单纯化疗相比，信迪利单抗或卡瑞利珠单抗联合化疗似乎能实现最佳的无进展生存期（风险比=0.56，95%CI 0.46-0.68）。纳武利尤单抗联合化疗似乎能提供最佳的客观缓解率，与单纯化疗相比有显著差异（优势比=0.49，95%CI 0.38-0.64）。纳武利尤单抗联合伊匹木单抗导致≥3级不良事件的发生率相对低于其他方案。
与单纯化疗相比，免疫检查点抑制剂（ICI）与化疗联合使用为晚期ESCC患者提供了更高的有效治疗概率。在一线治疗中，特瑞普利单抗和信迪利单抗联合化疗分别被列为提供最高总生存期和无进展生存期获益的方案。
