Published online Nov 15, 2020. doi: 10.4251/wjgo.v12.i11.1346
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
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.
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.
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.
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).
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.
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.
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.