First-line treatment options for advanced gastric/gastroesophageal junction cancer patients with PD-L1-positive: a systematic review and meta-analysis

Ling Fan; Ning Lu; Lingmin Zhang; Jie Zhang; Jie Li; Manli Cui; Mingxin Zhang

doi:10.1097/MS9.0000000000000765

First-line treatment options for advanced gastric/gastroesophageal junction cancer patients with PD-L1-positive: a systematic review and meta-analysis

Ann Med Surg (Lond). 2023 May 3;85(6):2875-2883. doi: 10.1097/MS9.0000000000000765. eCollection 2023 Jun.

Authors

Ling Fan¹, Ning Lu¹, Lingmin Zhang², Jie Zhang¹, Jie Li¹, Manli Cui¹, Mingxin Zhang^{1

3}

Affiliations

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

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.

Keywords: Immune checkpoint inhibitors; PD-1 inhibitors; advanced GC/GEJC; meta-analysis.