Efficacy and Safety of First-line Therapies for Advanced Unresectable Oesophageal Squamous Cell Cancer: a Systematic Review and Network Meta-analysis

Abstract

AimTo compare the clinical efficacy and safety of first-line treatments for advanced unresectable oesophageal squamous cell cancer. Materials and methodsA systematic review and network meta-analysis was carried out by retrieving and retaining relevant literature from databases. The studies were randomised controlled trials comparing first-line treatments for advanced unresectable oesophageal squamous cell cancer. A Bayesian network meta-analysis was used to assess clinical outcomes. ResultsNine studies including 4499 patients receiving first-line treatments were analysed. For all populations, toripalimab plus chemotherapy tended to provide the best overall survival (hazard ratio 0.58, 95% confidence intervals 0.43–0.78) and sintilimab plus chemotherapy provided the best progression-free survival (0.56, 0.46–0.68). Nivolumab plus chemotherapy presented the best objective response rate (odds ratio 2.45, 1.78–3.42) and camrelizumab plus chemotherapy (0.47, 0.29–0.74) appeared to be the safest. Sintilimab plus chemotherapy (0.55, 0.40–0.75) and nivolumab (0.54, 0.37–0.80) plus chemotherapy had the best overall survival in programmed death ligand 1 (PD-L1) tumour proportion score <1% and ≥1% subgroups. Toripalimab plus chemotherapy (0.61, 0.40–0.93) and pembrolizumab (0.57, 0.43–0.75) were the best in overall survival in combined positive score <10 and ≥10 subgroups, respectively. Toripalimab plus chemotherapy showed the best overall survival in the Asian group; pembrolizumab presented better overall survival in the Asian population than the non-Asian group. ConclusionMost immunotherapy combined with chemotherapy showed superior clinical benefits and sintilimab plus chemotherapy, toripalimab plus chemotherapy and tislelizumab plus chemotherapy had better comprehensive clinical efficacy. PD-L1 expression detection and ethnicity differences are still of great significance and most suitable regimens varied from each subgroup.