Efficacy and Safety of Recombinant Human p53 Adenovirus Injection Combined with Radiotherapy or Concurrent Chemoradiotherapy in the Treatment of Cervical Cancer: A Systematic Review and Meta-analysis.

ABSTRACT

Objective: Cervical cancer remains a major health concern globally, and combined modality treatment often includes radiotherapy or concurrent chemoradiotherapy. Recently, recombinant human adenovirus-p53 (rAd-p53) has been introduced as a promising agent in treatment of cervical cancer. Methods: We conducted a systematic review and meta-analysis following the PRISMA guidelines. RCTs were identified through electronic databases without limitations on time or language. The studies should include patients diagnosed with cervical cancer receiving either rAd-p53 combined with radiotherapy or concurrent chemoradiotherapy (RT/CRT) or RT/CRT alone. Primary outcome measures were complete response rate (CRR) and objective response rate (ORR), as defined by WHO's criteria for solid tumor therapeutic evaluation. Secondary outcome measures included adverse reaction incidence. Results: We included 9 RCTs in the analysis. Meta-analysis revealed that rAd-p53 combined with radiotherapy or concurrent chemoradiotherapy significantly improved the CRR [OR = 1.67, 95%CI (1.29, 2.16), P < .0001] and ORR [OR = 1.26, 95%CI (1.15,1.37), P < .001] compared to radiotherapy or concurrent chemoradiotherapy alone. The incidence of fever was higher in the combination therapy group [OR = 2.80, 95%CI (1.40, 5.62), P < .001], but no significant differences were observed in the incidence of other adverse reactions. Conclusions: The combination of rAd-p53 with radiotherapy or concurrent chemoradiotherapy exhibits enhanced therapeutic efficacy in the treatment of cervical cancer without a significant increase in severe adverse reactions. However, multicenter, large-scale, randomized clinical trials are warranted for further validation.