Yu Yan, Huang Lin, Yan Rong, Jiang Min, Li Shuang-Jiao, Fan Wang-Dong
West China School of Public Health, Sichuan University, Chengdu, Sichuan, China.
West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China.
Front Oncol. 2024 Dec 2;14:1416943. doi: 10.3389/fonc.2024.1416943. eCollection 2024.
To systematically evaluate the efficacy and safety of PD-1 inhibitors in neoadjuvant therapy for locally advanced colorectal cancer (LACRC).
Retrieved from PubMed, Embase, and the Cochrane Library, all relevant studies about PD-1 inhibitors for neoadjuvant treatment of LACRC were collected from inception to 31 December 2023. The efficacy was assessed by the rate of pathological complete response (PCR), clinical complete response (CCR), and major pathological response (MPR), and the safety was evaluated by the incidence of all adverse effects (TRAEs). Subgroup analysis was conducted by experimental design, types of PD-1 inhibitors, and disease types.
A total of 803 patients were included in 21 studies. The results of the meta-analysis showed that the PCR rate of PD-1 inhibitors in the treatment of LACRC was 54% (95% CI: 43%-65%, P<0.05); the CCR of anti-PD-1 was 40% (95% CI: 26%-54%, P<0.05); the MPR was 66% (95% CI: 56%-76%, P<0.05); and the irAEs was 27% (95% CI: 17%-37%, P<0.05). Subgroup analysis showed that the PCRs in prospective studies and retrospective studies were 49% (95% CI: 32%-66%, P<0.05) and 57% (95% CI: 42%-73%, P<0.05), respectively. Among the 803 patients, 619 (77%) were diagnosed with rectal cancer (RC), and the PCR and MPR were 49% and 65%, respectively; 184 (23%) were diagnosed with colorectal cancer (CRC), and the PCR and MPR were both 67%. In our meta-analysis, types of PD-1 inhibitors, including sintilimab, toripalimab, camrelizumab, avelumab, pembrolizumab, and tislelizumab, and patients who received PD-1 inhibitors alone or in combination achieved good PCR rates.
Neoadjuvant therapy combined with a PD-1 inhibitor has a favorable PCR and relatively low incidences of irAEs for patients with LACRC, suggesting that this regimen including a PD-1 inhibitor is significantly effective and sufficiently safe.
系统评价程序性死亡蛋白1（PD-1）抑制剂在局部晚期结直肠癌（LACRC）新辅助治疗中的疗效和安全性。
从PubMed、Embase和Cochrane图书馆检索2023年12月31日前所有关于PD-1抑制剂用于LACRC新辅助治疗的相关研究。疗效通过病理完全缓解（PCR）率、临床完全缓解（CCR）率和主要病理缓解（MPR）率进行评估，安全性通过所有不良反应（TRAEs）的发生率进行评估。按实验设计、PD-1抑制剂类型和疾病类型进行亚组分析。
21项研究共纳入803例患者。荟萃分析结果显示，PD-1抑制剂治疗LACRC的PCR率为54%（95%CI：43%-65%，P<0.05）；抗PD-1的CCR率为40%（95%CI：26%-54%，P<0.05）；MPR率为66%（95%CI：56%-76%，P<0.05）；免疫相关不良反应（irAEs）发生率为27%（95%CI：17%-37%，P<0.05）。亚组分析显示，前瞻性研究和回顾性研究的PCR率分别为49%（95%CI：32%-66%，P<0.05）和57%（95%CI：42%-73%，P<0.05）。在803例患者中，619例（77%）被诊断为直肠癌（RC），PCR率和MPR率分别为49%和65%；184例（23%）被诊断为结肠癌（CRC），PCR率和MPR率均为67%。在我们的荟萃分析中，包括信迪利单抗、特瑞普利单抗、卡瑞利珠单抗、阿维鲁单抗、帕博利珠单抗和替雷利珠单抗在内的PD-1抑制剂类型，以及单独或联合使用PD-1抑制剂的患者均取得了良好的PCR率。
新辅助治疗联合PD-1抑制剂对LACRC患者具有良好的PCR率且irAEs发生率相对较低，表明含PD-1抑制剂的治疗方案具有显著疗效且足够安全。
