Abstract
Programmed death 1 (PD-1) and PD ligand 1 (PD-L1) inhibitors have demonstrated varying effectiveness in treating esophageal or gastric/gastroesophageal junction (G/GEJ) cancer. Hence, this systematic review and meta-analysis evaluated the efficacy and safety of anti-PD-1/PD-L1 treatment in patients with esophageal or G/GEJ cancer by analyzing the types of medications. Randomized controlled trials comparing anti-PD-1/PD-L1 to control therapy were identified by searching PubMed, EMBASE, and ClinicalTrials.gov. The outcomes included overall survival (OS), progression-free survival (PFS) rates, and serious adverse events (SAEs), evaluating the differences in therapy types, including a comparison between PD-1 and PD-L1 inhibitors. Eight studies were included in the analysis. PD-1/PD-L1 inhibitors affected the overall OS rate increment without influencing the PFS rate (HR, 0.837; 95% CI, 0.753–0.929; p = 0.001; HR 0.991; 95% CI, 0.778–1.263; p = 0.942, respectively). Anti-PD-1 was significantly more beneficial for increasing OS and PFS than PD-L1 inhibitors. Anti-PD-1 and PD-L1 use was not significantly associated with SAE development in esophageal or G/GEJ cancer patients. PD-1/PD-L1 inhibitor use was associated with improved OS and PFS rate increase among PD-1 and PD-L1 inhibitors. Considering response variations to anti-PD-1/PD-L1 usage, more individualized treatments should be introduced in clinical practice.
Highlights
Esophageal or gastric/gastroesophageal junction (G/GEJ) cancer is one of the most fatal cancers [1,2]
A meta-analysis conducted by Wang et al [8] suggested that treating esophageal or G/GEJ cancer with Programmed death 1 (PD-1)/PD ligand 1 (PD-L1) inhibitors resulted in a higher pooled hazard ratio (HR) for overall survival (OS) and progression-free survival (PFS), indicating their ineffectiveness
Our analysis revealed that PD-1/PD-L1 inhibitors significantly prolonged the OS as compared to the control, while no significant effect on the PFS was observed in patients with esophageal or G/GEJ cancer
Summary
Esophageal or gastric/gastroesophageal junction (G/GEJ) cancer is one of the most fatal cancers [1,2]. With regard to pathophysiological ensurance, various clinical studies have been conducted to provide empirical evidence for evaluating the effects of PD-1/PD-L1 inhibitors on esophageal or G/GEJ cancer—a cancer type with a low survival rate [6,8]. Even the outcomes of systematic reviews and meta-analysis studies have not been able to provide conclusive information on the clinical benefits of PD-1/PD-L1 inhibitor usage for treatment of esophageal or G/GEJ cancer, as opposed to chemotherapies [6,8,9,10]. Chen et al [6] reported that PD-1/PDL1 inhibitors were more effective than control therapy in the treatment of esophageal or G/GEJ cancer, demonstrating increased pooled odds ratios (ORs) for OS and PFS. Since multiple indirect comparison trials are required to produce a sufficient level of power and precision as a single head-to-head trial [14], performing a future meta-analysis with head-to-head trials on the efficacy of anti-PD-1/PD-L1 for esophageal or G/GEJ cancer treatment is essential
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