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Immune checkpoint inhibitors’ combination therapy as first-line treatment in advanced esophageal squamous cell carcinoma: a meta-analysis

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Abstract

Purpose

The benefit of immune checkpoint inhibitors’ (ICIs) combination therapy in patients with advanced esophageal squamous cell carcinoma (ESCC) remained unclear. We performed a meta-analysis to explore the efficacy and safety of ICIs’ combination therapy versus chemotherapy alone as first-line treatment in advanced ESCC.

Methods

A systematic review of randomized controlled trials (RCTs) of ICIs’ combination therapy as first-line treatment in advanced ESCC was conducted via searching PubMed, Embase, and Cochrane database. The data for efficacy and safety of ICIs’ combination therapy were subject to meta-analysis. Subgroup analysis was performed in patients with different PD-L1 expression status.

Results

A total of 5 RCTs and 3163 patients were included. Overall, the hazard ratio (HR) for overall survival (OS) benefit with ICIs’ combination therapy was 0.68 (95% CI 0.62–0.75) compared with chemotherapy alone. The HR for progression-free survival (PFS) benefit and the odds ratio (OR) for overall response rate (ORR) increase were 0.62 (95% CI 0.56–0.68) and 2.01 (95% CI 1.70–2.38), respectively. The OS and PFS benefits with ICIs’ combination therapy over chemotherapy alone were also observed in the subgroup of PD-L1 positive expression, but not in the subgroup of PD-L1 negative expression. The incidence of grade 3 or higher treatment-related adverse events was 60.4% with ICIs’ combination therapy and 56.3% with chemotherapy alone (OR, 1.19; 95% CI 0.90–1.57).

Conclusion

ICIs’ combination therapy showed superior OS, PFS, and ORR over chemotherapy alone with a manageable safety profile. These results suggested that ICIs’ combination therapy can be considered as a new first-line treatment for advanced ESCC.

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Author notes

  1. Dianhe Li and Ling Tang have contributed equally to the study.

Authors and Affiliations

  1. Department of Oncology, Panyu Central Hospital, No. 8 Fuyu Road East, Panyu, Guangzhou, Guangdong, People’s Republic of China

    Dianhe Li, Jiazhu Hu, Xiaolong Cao & Yan He

  2. Department of Otolaryngology-Head and Neck Surgery, Panyu Central Hospital, Guangzhou, People’s Republic of China

    Ling Tang

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  1. Dianhe Li
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  2. Ling Tang
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  3. Jiazhu Hu
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  4. Xiaolong Cao
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Contributions

All authors contributed to the interpretation of results and development of the manuscript, including approval for submission. DL and YH designed the study. DL, LT, JH and XC collected and analyzed the data. All authors contributed to the article and approved the submitted version.

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Correspondence to Yan He.

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Li, D., Tang, L., Hu, J. et al. Immune checkpoint inhibitors’ combination therapy as first-line treatment in advanced esophageal squamous cell carcinoma: a meta-analysis. J Cancer Res Clin Oncol 149, 933–939 (2023). https://doi.org/10.1007/s00432-022-04066-2

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