Yu Jiaojiao, Wang Zhijing, Li Mingxu, Zhu Hua, Tang Xiaoxia, Luan Ke, Zhi Yinhuan, Yin Shan, Su Yuanqi, Long Jingyan, He Qubo, Quan Jieru, Li Chenchen
Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China.
Front Pharmacol. 2025 May 16;16:1570467. doi: 10.3389/fphar.2025.1570467. eCollection 2025.
The objective of this meta-analysis was to assess the effectiveness and safety of neoadjuvant PD-1/L1 inhibitors plus chemoradiotherapy(CRT) for locally advanced rectal cancer (LARC).
Databases including PubMed, Embase, Cochrane Library and Web of Science were examined for pertinent studies. Meta-analyses were conducted on pathological complete response (pCR), clinical complete response (cCR), major pathologic response (MPR), sphincter-sparing surgery (SSS), R0 resection, surgery rate, Grade≥3 adverse events (AEs), and 3-year disease-free survival (DFS).
The combined percentages of pCR, cCR, MPR, SSS, R0 resection rate, surgery rate, and 3-year DFS were 30.8%, 20.8%, 57.6%, 70.3%, 75.8%, 83.5%, and 76%, respectively. Grade ≥3 AEs manifested in 33.9% of cases. In subgroup analysis, mismatch repair-deficient (dMMR) or microsatellite instability-high (MSI-H) showed 50.2% pCR and 64.7% MPR. Long-course radiotherapy (LCRT) and short-course radiotherapy (SCRT) had 39.1% and 27.1% pCR rates. The contemporaneous and sequential immuno-chemoradiotherapy subgroups had 30.8% and 30.1% pCR rates. These rates matched the 33.1% and 30% pCR rates for the PD-L1 and PD-1 inhibitor subgroups. The PD-L1 and PD-1 inhibitor categories had 20.6% and 38.8% rate of Grade ≥3AEs.
Neoadjuvant PD-1/PD-L1 inhibitors plus CRT have demonstrated favourable response rates and tolerable toxicity profiles for LARC.
PROSPERO (CRD42024569289) https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024569289.
本荟萃分析的目的是评估新辅助PD-1/L1抑制剂联合放化疗（CRT）治疗局部晚期直肠癌（LARC）的有效性和安全性。
检索包括PubMed、Embase、Cochrane图书馆和Web of Science在内的数据库以查找相关研究。对病理完全缓解（pCR）、临床完全缓解（cCR）、主要病理缓解（MPR）、保肛手术（SSS）、R0切除、手术率、≥3级不良事件（AE）和3年无病生存率（DFS）进行荟萃分析。
pCR、cCR、MPR、SSS、R0切除率、手术率和3年DFS的合并百分比分别为30.8%、20.8%、57.6%、70.3%、75.8%、83.5%和76%。≥3级AE出现在33.9%的病例中。在亚组分析中，错配修复缺陷（dMMR）或微卫星高度不稳定（MSI-H）显示pCR为50.2%，MPR为64.7%。长程放疗（LCRT）和短程放疗（SCRT）的pCR率分别为39.1%和27.1%。同步和序贯免疫放化疗亚组的pCR率分别为30.8%和30.1%。这些率与PD-L1和PD-1抑制剂亚组的33.1%和30%的pCR率相符。PD-L1和PD-1抑制剂类别中≥3级AE的发生率分别为20.6%和38.8%。
新辅助PD-1/PD-L1抑制剂联合CRT已显示出对LARC有良好的缓解率和可耐受的毒性特征。
PROSPERO（CRD42024569289）https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024569289 。
