Meta-Analysis
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Nov 15, 2020; 12(11): 1346-1363
Published online Nov 15, 2020. doi: 10.4251/wjgo.v12.i11.1346
Efficacy and safety of anti-PD-1/anti-PD-L1 antibody therapy in treatment of advanced gastric cancer or gastroesophageal junction cancer: A meta-analysis
Li Yang, Xian-Zhe Dong, Xiao-Xuan Xing, Xiao-Hui Cui, Lin Li, Lan Zhang
Li Yang, Xian-Zhe Dong, Xiao-Xuan Xing, Xiao-Hui Cui, Lin Li, Lan Zhang, Department of Pharmacy, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing Engineering Research Center for Nervous System Drugs, Beijing Institute for Brain Disorders, Key Laboratory for Neurodegenerative Diseases of Ministry of Education, Beijing 100053, China
Li Yang, College of Pharmacy, Zunyi Medical University, Zunyi 563000, Guizhou Province, China
Author contributions: Yang L and Dong XZ designed the study and wrote the manuscript; Yang L and Xing XX conducted the literature search; Yang L and Dong XZ collected and retrieved the data; Yang L and Cui XH analyzed the data; Dong XZ, Li L, and Zhang L critically reviewed and revised the manuscript; and all authors proofread the manuscript.
Supported by Beijing Hospitals Authority Ascent Plan, No. DFL20190803; Capital Science and Technology Leading Talent Training Project, No. Z191100006119017; National Nature and Science Foundation of China, No. 81773778; and China Postdoctoral Science Foundation, No. 2019M650775.
Conflict-of-interest statement: No conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lan Zhang, PhD, Professor, Department of Pharmacy, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing Engineering Research Center for Nervous System Drugs, Beijing Institute for Brain Disorders, Key Laboratory for Neurodegenerative Diseases of Ministry of Education, No. 45 Changchun Street, Xicheng District, Beijing 100053, China. lanizhg@126.com
Received: June 9, 2020
Peer-review started: June 9, 2020
First decision: July 4, 2020
Revised: July 15, 2020
Accepted: September 18, 2020
Article in press: September 18, 2020
Published online: November 15, 2020
ARTICLE HIGHLIGHTS
Research background

Many clinical trials have confirmed that advanced gastric cancer or gastroesophageal junction cancer (GC/GEJC) patients can benefit from anti-PD-1/anti-PD-L1 antibody therapy. In addition, Epstein-Barr virus and microsatellite instability subtype gastric cancer patients tend to have high PD-L1 expression. Therefore, anti-PD-1/anti-PD-L1 antibody therapy may become a potential treatment for advanced GC/GEJC patients.

Research motivation

To better assess the efficacy and safety of anti-PD-1/anti-PD-L1 antibody therapy, we integrated data from 13 eligible studies for a systematic review and meta-analysis.

Research objectives

The purpose of this meta-analysis was to clarify the efficacy and safety of anti-PD-1/anti-PD-L1 antibody therapy in advanced GC/GEJC patients.

Research methods

PubMed, Web of Science, Cochrane Library, and EMBASE databases were searched to extract relevant data according to the designed extraction scheme, and conduct statistical analysis using Review Manger 5.3 and STATA 14.0 software. The main outcomes of this study included the objective response rate (ORR), disease control rate (DCR), overall survival (OS), free survival (PFS), and adverse events (AEs).

Research results

Our meta-analysis showed that the combined ORR and DCR were 15% (95%CI: 14%-18%) and 40% (95%CI: 33%-46%), respectively. The combined 6-mo OS and PFS were 54% (95%CI: 45%-64%) and 26% (95%CI: 20%-32%) respectively, and the 12-mo OS and PFS were 42% (95 %CI: 21%-62%) and 11% (95%CI: 8%-13%). In addition, the incidence of any grade AEs and ≥ 3 grade AEs was 64% (95%CI: 54%-73%) and 18% (95%CI: 16%-20%), respectively.

Research conclusions

Anti-PD-1/anti-PD-L1 antibody therapy has good anti-tumor efficacy with manageable AEs in advanced GC/GEJC patients. In addition, under the premise of paying close attention to safety of the treatment, it offers even better efficacy in combination with chemotherapy.

Research perspectives

This meta-analysis demonstrated the efficacy and safety of anti-PD-1/anti-PD-L1 antibody therapy and high ORR for advanced GC/GEJC patients with overexpression of PD-L1. Furthermore, when paying close attention to the safety of treatment, it seems that combination with conventional chemotherapy treatment can achieve better clinical efficacy. This study has some limitations. The future research direction can be to verify the efficacy and safety of anti-PD-1/anti-PD-1 antibody combined with chemotherapy in patients with advanced GC/GEJC.