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Meta-Analysis
. 2021 Aug 23;13(16):20468-20480.
doi: 10.18632/aging.203429. Epub 2021 Aug 23.

The efficacy and safety of PD-1/PD-L1 immune checkpoint inhibitors in treating advanced urothelial cancer: a meta-analysis of clinical trials

Fei Li  1 , Yu Wang  1 , Kunfeng Xie  1 , Yunze Fang  1 , Yuejun Du  1 , Lina Hou  2 , Wanlong Tan  1
Affiliations
Meta-Analysis

The efficacy and safety of PD-1/PD-L1 immune checkpoint inhibitors in treating advanced urothelial cancer: a meta-analysis of clinical trials

Fei Li et al. Aging (Albany NY). .

Abstract

Survival outcomes in advanced urothelial cancer (UC) are dismal. Over the past years, immunotherapy remains an evolving treatment modality for these patients. This meta-analysis was performed to comprehensively evaluate the efficacy and safety of immune checkpoint inhibitors. For this purpose, 18 clinical trials comprising a total of 3,144 patients were identified from the PubMed database up to September 2020. Overall, the objective response rate (ORR) to PD-1/PD-L1 inhibitors was 0.20 [95% confidence intervals (CI) 0.17-0.23]. Furthermore, the pooled 1-year overall survival (OS) and 1-year progression-free survival (PFS) rates were 0.43 (95% CI 0.33-0.53) and 0.19 (95% CI 0.17-0.21), respectively. The summary rates of any-grade and grade ≥3 adverse events (AEs) were 0.66 (95% CI 0.58-0.74) and 0.13 (95% CI 0.09-0.18), respectively. Among the different subgroups, PD-1/PD-L1 inhibitors elicited a promising ORR in patients with lymph node-only metastasis compared to those with visceral metastasis (0.41 VS. 0.17). Additionally, patients with primary tumor in the lower tract had higher ORR compared to those with primary tumor in the upper tract (0.24 VS. 0.15). Briefly speaking, this immunotherapy protocol showed an encouraging efficacy and acceptable safety profile in the treatment of advanced UC. Moreover, our findings provided potential clinical significance for patients with lymph node-only metastasis or primary tumor in the lower tract. However, these exciting findings need further confirmation.

Keywords: efficacy; immunotherapy; meta-analysis; safety; urothelial cancer.

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Conflict of interest statement

CONFLICTS OF INTEREST: The authors declare no conflicts of interest related to this study.

Figures

Figure 1
Figure 1
Flow chart of the study selection procedure.
Figure 2
Figure 2
Forest plot of the efficacy of immune checkpoint inhibitors in treating patients with advanced urothelial cancer. (A) Pooled objective response rate. (B) Pooled 1-year overall survival rate. (C) Pooled 1-year progress free survival rate. The diamonds represent the pooled indexes. The line crossing the square represents the 95% CI. I2 indicates the heterogeneity in each subgroup meta-analysis. P demonstrates the significance of differences between the subgroups.
Figure 3
Figure 3
Forest plot of the subgroup outcomes. (A) Pooled ORR of patients with visceral metastasis. (B) Pooled ORR of patients with lymph node only metastasis. (C) Pooled ORR of patients with the primary tumor in the upper tract. (D) Pooled ORR of patients with the primary tumor in the lower tract. The diamonds represent the pooled indexes. The line crossing the square represents the 95% CI. I2 indicates the heterogeneity in each subgroup meta-analysis. P demonstrates the significance of differences between the subgroups.
Figure 4
Figure 4
Forest plot of the safety of immune checkpoint inhibitors in treating patients with advanced urothelial cancer. (A) Pooled any-grade adverse events rate. (B) Pooled grade ≥3 adverse events rate. The diamonds represent the pooled indexes. The line crossing the square represents the 95% CI. I2 indicates the heterogeneity in each subgroup meta-analysis. P demonstrates the significance of differences between the subgroups.
See this image and copyright information in PMC

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