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Archive > Volume 29 Issue 4 > 2022,29(4):338-344. DOI:10.3872/j.issn.1007-385X.2022.04.010 Prev Next
Clinical Research
Efficacy and safety of single-agent PD-1 inhibitors versus chemotherapy in second-line treatment of advanced esophageal squamous cell carcinoma: a Meta-analysis
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Abstract:
Objective: To systematically review the effectiveness and safety of single-agent programmed cell death-1 (PD-1) inhibitors versus the second-line chemotherapy in advanced esophageal squamous cell carcinoma (ESCC) patients in order to provide optimal evidence-based medical proof for clinical decision-making. Methods: Relevant literatures about randomized controlled trails (RCTs) of single-agent PD-1 inhibitors versus traditional second-line chemotherapy in treating advanced ESCC patients were retrieved through The Cochrane Library, Web of science, PubMed, EMbase, CNKI and Wanfang data, J Clin Oncol, N England Oncol and Lancet Oncol, etc. as well as ASCO and ESMO meeting abstract. The data were extracted for Meta-analysis which was conducted using RevMan5.3 software. Results: Totally 5 RCT with 1732 patients were included in this study. The Meta-analysis showed that compared with chemotherapy, single-agent PD-1 inhibitors significantly prolonged the OS (overall survival) (HR＝0.75, 95% CI: 0.67-0.83, P<0.000 01) of advanced ESCC patients. In the sub-group analysis based on different PD-L1 expression, results showed that while the TPS<1%, second-line single-agent PD-1 inhibitors showed no obvious advantage in extending the OS of advanced ESCC patients; but when TPS≥1%, TPS<5%, TPS≥5%, TPS<10% or TPS≥10%, single- agent PD-1 inhibitors significantly prolonged the OS of advanced ESCC patients, with more significant effect in patients with higher PD-L1 level. However, there was no statistical significance in prolonging PFS (progression-free survival) (HR＝0.93, 95% CI: 0.79-1.10, P=0.41) or increasing ORR (objective response rate) (RR=1.62, 95% CI: 0.95-2.74, P=0.07) between single-agent PD-1 inhibitors and chemotherapy. Compared with chemotherapy group, the incidence of grade 3-5 treatment-related adverse effect was lower in the single drug PD-1 inhibitor group (RR=0.37, 95% CI: 0.28-0.50, P<0.000 01). Conclusion: Second-line single-agent PD-1 inhibitors can significantly prolong the OS of advanced ESCC patients with good safety. Single-agent PD-1 inhibitors should be used as the preferential second-line treatment in advanced ESCC patient with high PD-L1 expression.
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Clc Number:
R735.1; R730.2; R730.7
