Affiliation:
1. Department of Gastroenterology, The First Affiliated Hospital of Xi’an Medical University
2. Department of Anesthesiology, First Affiliated Hospital, Xi’an Jiaotong University, Xi’an
3. Shaanxi University of Traditional Chinese Medicine, Xianyang, Shaanxi, China
Abstract
Background:
Lately, many trials have paid much attention on the oncological outcomes of immunotherapy combined with chemotherapy as a first-line treatment. The authors perform a systematic meta-analysis to assess the efficacy and safety of programmed death 1 inhibitor plus chemotherapy for first-line treatment in advanced gastric/gastroesophageal junction cancer.
Materials and methods:
Literature search through major databases in English and Chinese: PubMed, Embase, Cochrane library, web of Science and CNKI updated on 10 March 2023. Randomized controlled trials were selected to investigate chemotherapy plus programmed death 1 inhibitor versus chemotherapy.
Results:
A total of 7 randomised controlled trials including 5788 participants were included. The overall survival (hazard ratio=0.79;95% CI: 0.74–0.85, P<0.01), progression-free survival (hazard ratio=0.72; 95% CI: 0.67–0.77, P<0.01) and objective response rate (risk ratio=1.24,95% CI: 1.18–1.31, P<0.05) were longer than chemotherapy alone in the pooled analysis. For subgroup analyses of overall survival, programmed death 1 inhibitors plus chemotherapy had a significant advantage in patients with combined positive score greater than or equal to 5, in Asia, in men and in those younger than 65 years (P<0.01), as were immune-mediated adverse events (odds ratio=8.86;95% CI: 1.26–62.47,P<0.05) and treatment-related grade 3–5 adverse events (odds ratio=1.40,95% CI:1.20–1.62, P<0.01).
Conclusion:
Programmed death 1 inhibitors plus chemotherapy have significant antitumour activity compared to chemotherapy alone. However, it is riskier in terms of toxicity than chemotherapy. The authors recommend programmed death 1 inhibitors plus chemotherapy as the optimal treatment regimen for patients with positive programmed death ligand 1 expression, in Asia, male and less than 65 years of age. More well-designed studies are needed to investigate the efficacy and safety of different immune plus chemotherapy drug doses and regimens.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Cited by
1 articles.
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