"Efficacy and safety of immunochemotherapy, immunotherapy, chemotherapy, and targeted therapy as first-line treatment for advanced and metastatic esophageal cancer: a systematic review and network meta-analysis"

作者全名："Gao, Zhen; Huang, Shujie; Wang, Sichao; Tang, Dezhao; Xu, Wei; Zeng, Ruijie; Qiao, Guibin"

作者地址："[Gao, Zhen; Huang, Shujie; Wang, Sichao; Tang, Dezhao; Qiao, Guibin] Southern Med Univ, Guangdong Acad Med Sci, Guangdong Prov Peoples Hosp, Dept Thorac Surg, Guangzhou, Peoples R China; [Gao, Zhen] Queen Mary Univ London, Barts Canc Inst, Ctr Canc Cell & Mol Biol, John Vane Sci Ctr, Charterhouse Sq, London, England; [Wang, Sichao] Univ Hong Kong, Li Ka Shing Fac Med, Dept Clin Oncol, Hong Kong, Peoples R China; [Wang, Sichao] Univ Hong Kong, Shenzhen Hosp, Dept Clin Oncol, Shenzhen, Peoples R China; [Xu, Wei] Chongqing Med Univ, Sch Publ Hlth, Chongqing, Peoples R China; [Zeng, Ruijie] Southern Med Univ, Guangdong Prov Peoples Hosp, Guangdong Acad Med Sci, Dept Gastroenterol, Guangzhou, Peoples R China"

通信作者："Qiao, GB (通讯作者)，Southern Med Univ, Guangdong Acad Med Sci, Guangdong Prov Peoples Hosp, Dept Thorac Surg, Guangzhou, Peoples R China."

来源：LANCET REGIONAL HEALTH-WESTERN PACIFIC

ESI学科分类：　

WOS号：WOS:001058102200001

JCR分区：Q1

影响因子：7.6

年份：2023

卷号：38

期号：　

开始页：　

结束页：　

文献类型：Review

关键词：Esophageal carcinoma; Immunotherapy; Chemotherapy; PD-L1; Metastasis; Overall survival

摘要："Background The treatment of esophageal cancer has entered a new phase with the development of immunotherapy. The current investigation purpose is to investigate and contrast the efficacy and safety of immunotherapy, immu-nochemotherapy, chemotherapy, and targeted therapy as first-line treatment for individuals suffering from advanced and metastatic esophageal cancer.Methods Within the framework of this systematic review and network meta-analysis, clinical trials published or reported in English up until 01 May, 2022, were retrieved from Embase, PubMed, Cochrane Central Register of Controlled Trials, the ClinicalTrials.gov databases, ESMO, and ASCO. The analysis incorporated randomized controlled trials (RCTs) from phase 2 to 3 that evaluated a minimum of two first-line therapeutic regimens for metastatic esophageal cancer were included in the analysis. The primary outcomes were overall survival (OS) and progression-free survival (PFS). Secondary clinical outcomes included the incidence of objective response rate (ORR), and adverse events (AEs) of any grade and & GE;3 grade. Relative summary data were extracted from included studies by GZ, HS, WS, and TD. For clear statistical analysis, chemotherapy was divided into two categories of fluorouracil-based chemotherapy (FbCT) and fluorouracil-free chemotherapy (FfCT). Bayesian frequentist approach was employed to conduct the network meta-analysis. The indirect intercomparison between regimens was presented with league tables (HRs and 95% CI for OS and PFS, ORs and 95% CI for ORR and AEs). A greater surface value under the cumulative ranking (SUCRA) indicates a higher potential ranking for the corresponding treatment. A further calculation of relative results about esophageal squamous cell cancer was performed in the subgroup analysis. The current protocol for the systematic review has been properly registered on PROSPERO (registration number: CRD42021241145). Findings The final analysis comprised 17 trials that involved 9128 patients and 19 distinct treatment regimens. Within the scope of investigated immunotherapy (IO) combinations, toripalimab + FfCT (tori + FfCT) demonstrated the best OS advantages (tori + FfCT vs. FbCT, HR 0.57, 95% CI 0.38-0.85; tori + FfCT vs. FfCT, HR 0.58, 95% CI 0.43-0.78). In terms of PFS, camrelizumab + FfCT (cam + FfCT) demonstrated the best PFS advantages (FbCT vs. cam + FfCT, HR 1.79, 95% CI 1.22-2.63; FfCT vs. cam + FfCT, HR 1.79, 95% CI 1.47-2.17). Nivolumab + FbCT (nivo + FbCT vs. FfCT, OR 3.29, 95% CI 1.43-7.56) showed the best objective responses. Compared to the conventional chemotherapy regimen, the toxicity was observed to be the slightest for the tori + FfCT (FbCT vs. tori + FfCT, OR 3.07, 95% CI 1.22-7.7) and sintilimab + FfCT (FbCT vs. sin + FfCT, OR 2.93, 95% CI 1.16-7.37). The results in this study were evaluated as having a low heterogeneity since the I2 value was & LE;25% in all analyses.Interpretation Compared to foreign IO combinations, sin + FfCT, tori + FfCT, cam + FfCT, and tisle + FbCT are superior first-line treatment options for patients with advanced and metastatic esophageal cancer. Although foreign IO combinations, such as pembro + FbCT and nivo + FbCT obtained better objective response rates than other IO combinations, the addition of chemotherapy to IO worsens the safety profiles. Our findings could provide complementary evidence for current guideline recommendations. Copyright & COPY; 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4.0/)."

基金机构："Science and Technology Program of Guangzhou, China [202206010103]; Natural Science Foundation of Guangdong Province [2022A1515012469]"

基金资助正文："This work was supported by a grant from the Science and Technology Program of Guangzhou, China (202206010103); and Natural Science Foundation of Guangdong Province (2022A1515012469)."