AI Article Synopsis

  • Recent trials indicate that combining PD-1 inhibitors with chemotherapy leads to better survival outcomes in patients with advanced esophageal squamous cell carcinoma (ESCC) compared to chemotherapy alone, though no definitive comparisons exist.
  • This study analyzed data from 4,162 patients across seven trials and found that PD-1 inhibitors increased median overall survival (OS) from 11.3 months to 15.6 months, with certain combinations offering the best results.
  • Key findings showed that the combinations of toripalimab, tislelizumab, and sintilimab yielded the longest OS, with sintilimab also demonstrating superior effectiveness over pembrolizumab for patients with higher combined positive scores.

Article Abstract

Background: Recently, a sum of trials of programmed cell death-1 (PD-1) inhibitors combined with chemotherapy have shown excellent efficacy compared to chemotherapy alone in patients with previously untreated, advanced esophageal squamous cell carcinoma (ESCC). However, there is no head-to-head comparison and consensus on which immunotherapy regimen results in better survival outcomes. This study aimed to evaluate the survival efficacy of various PD-1 inhibitor-based therapies in the first-line treatments for patients with advanced ESCC.

Methods: Data collected prior to 31 July 2023 were searched in the PubMed, Cochrane Library, Embase, Medline, and Web of Science databases. Overall survival (OS) and progression-free survival curves were pooled using the MetaSurv package. Survival data were compared by reconstructed individual patient data.

Results: A total of 4,162 patients and seven randomized controlled trials were included. After synthesizing, PD-1 inhibitors prolonged median OS from 11.3 months (95% CI (confidence interval) 10.7-11.7) to 15.6 months (95% CI 14.7-16.3). Based on reconstructed patient-level data, the toripalimab, tislelizumab, and sintilimab group achieved the longest OS, whereas the sintilimab and tislelizumab group had the lowest risk of recurrence than other treatments. In patients with a combined positive score of ≥10, sintilimab had better OS efficacy than pembrolizumab (HR: 0.71, 95% CI: 0.52-0.96). In terms of tumor proportion score of ≥1%, camrelizumab, nivolumab, and toripalimab showed proximate survival benefits in both OS and progression-free survival.

Conclusion: PD-1 inhibitor combined with chemotherapy significantly improved the survival time of patients with advanced ESCC. Toripalimab, tislelizumab, and sintilimab plus chemotherapy showed the best OS benefit. Longer progression-free benefits might be generated from adding tislelizumab and sintilimab to chemotherapy. Sintilimab was strongly recommended for patients with high programmed cell death-ligand 1 abundance.

Systematic Review Registration: [https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42024501086].

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11291229PMC
http://dx.doi.org/10.3389/fphar.2024.1408458DOI Listing

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