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Effectiveness and tolerability of programmed cell death protein-1 inhibitor + chemotherapy compared to chemotherapy for upper gastrointestinal tract cancers.
Zhang, Xiao-Min; Yang, Ting; Xu, Ying-Ying; Li, Bao-Zhong; Shen, Wei; Hu, Wen-Qing; Yan, Cai-Wen; Zong, Liang.
Affiliation
  • Zhang XM; Department of Central Laboratory, Changzhi People's Hospital, The Affiliated Hospital of Changzhi Medical College, Changzhi 046000, Shanxi Province, China.
  • Yang T; Department of Central Laboratory, Changzhi People's Hospital, The Affiliated Hospital of Changzhi Medical College, Changzhi 046000, Shanxi Province, China.
  • Xu YY; Department of Gastrointestinal Surgery, Yizheng People's Hospital, The Affiliated Hospital of Yangzhou University, Yangzhou 225000, Jiangsu Province, China.
  • Li BZ; Department of General Surgery, Anyang Tumor Hospital, Anyang 455000, Henan Province, China.
  • Shen W; Department of General Surgery, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi 214023, Jiangsu Province, China.
  • Hu WQ; Department of Gastrointestinal Surgery, Changzhi People's Hospital, The Affiliated Hospital of Changzhi Medical College, Changzhi 046000, Shanxi Province, China.
  • Yan CW; Department of Gastroenterology, Changzhi People's Hospital, The Affiliated Hospital of Changzhi Medical College, Changzhi 046000, Shanxi Province, China.
  • Zong L; Department of Central Laboratory, Changzhi People's Hospital, The Affiliated Hospital of Changzhi Medical College, Changzhi 046000, Shanxi Province, China.
World J Gastrointest Oncol ; 16(4): 1613-1625, 2024 Apr 15.
Article in En | MEDLINE | ID: mdl-38660631
ABSTRACT

BACKGROUND:

The combination of programmed cell death protein-1 (PD-1) inhibitor and chemotherapy is approved as a standard first- or second-line treatment in patients with advanced oesophageal or gastric cancer. However, it is unclear whether this combination is superior to chemotherapy alone.

AIM:

To assess the comparative effectiveness and tolerability of combining PD-1 inhibitors with chemotherapy vs chemotherapy alone in patients with advanced gastric cancer, gastroesophageal junction (GEJ) cancer, or oesophageal carcinoma.

METHODS:

We searched the PubMed and Embase databases for studies that compared the efficacy and tolerance of PD-1 inhibitors in combination with chemotherapy vs chemotherapy alone in patients with advanced oesophageal or gastric cancer. We employed either random or fixed models to analyze the outcomes of each clinical trial, encompassing data on overall survival (OS), progression-free survival (PFS), objective response rate, and adverse events (AEs).

RESULTS:

Nine phase 3 clinical trials (7016 advanced oesophageal and gastric cancer patients) met the inclusion criteria. Our meta-analysis demonstrated that the pooled PD-1 inhibitor + chemotherapy group had a significantly longer OS than the chemotherapy-alone group [hazard ratio (HR) = 0.76, 95% confidence interval (CI) 0.71-0.81]; the pooled PFS result was consistent with that of OS (HR = 0.67, 95%CI 0.61-0.74). The count of patients achieving an objective response in the PD-1 inhibitor + chemotherapy group surpassed that of the chemotherapy-alone group [odds ratio (OR) = 1.86, 95%CI 1.59-2.18]. AE incidence was also higher in the combination-therapy group than in the chemotherapy-alone group, regardless of whether ≥ grade 3 only (OR = 1.30, 95%CI 1.07-1.57) or all AE grades (OR = 1.88, 95%CI 1.39-2.54) were examined. We performed a subgroup analysis based on the programmed death-ligand 1 (PD-L1) combined positive score (CPS) and noted extended OS and PFS durations within the CPS ≥ 1, CPS ≥ 5, and CPS ≥ 10 subgroups of the PD-1 inhibitor + chemotherapy group.

CONCLUSION:

In contrast to chemotherapy alone, the combination of PD-1 inhibitor and chemotherapy appears to present a more favorable option for initial or subsequent treatment in patients with gastric cancer, GEJ tumor, or oesophageal cancer. This holds true particularly for individuals with PD-L1 CPS scores of ≥ 5 and ≥ 10.
Key words

Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: World J Gastrointest Oncol Year: 2024 Document type: Article Affiliation country: China Country of publication: China

Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: World J Gastrointest Oncol Year: 2024 Document type: Article Affiliation country: China Country of publication: China