Clinical Benefits of Combination Immunotherapy Over Standard Immunotherapy Monotherapy in Previously Treated Advanced Esophageal Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis
Abstract
PURPOSE: Programmed cell death protein 1 (PD-1) inhibitor monotherapy is the standard second-line treatment for esophageal squamous cell carcinoma (ESCC), but the clinical response and survival outcomes still remain unsatisfactory. This systematic review aims to assess the efficacy and safety of combined immunotherapy strategies in previously treated ESCC patients.
METHODS AND MATERIALS: Studies involving previously treated ESCC patients treated with either combined immunotherapy or PD-1 inhibitor monotherapy as second- or later-line treatment were searched up to November 30, 2023. Pooled rates of objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS), and treatment-related adverse events (TRAEs) were compared.
RESULTS: A total of 19 studies involving 3007 ESCC patients were included in the pooled analysis. Among them, 1308 patients received immunotherapy monotherapy. Combination immunotherapy included PD-1 inhibitor combined with chemotherapy (123 patients), anti-angiogenesis therapy (291 patients), chemoradiotherapy (49 patients), TIGIT inhibitor (62 patients), and anti-EGFR antibody (28 patients). Patients receiving combination immunotherapy had significantly higher ORR, DCR, PFS, and OS rates compared to those receiving PD-1 inhibitor monotherapy or chemotherapy (ORR: 35.5% vs. 19.8% vs. 13.0%, p = 0.000; DCR: 84.8% vs. 51.2% vs. 55.2%, p = 0.000). Subgroup analysis demonstrated that second-line combination…
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Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 3,007 participants or records.
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