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SYSTEMATIC REVIEW article

Front. Med.
Sec. Gastroenterology
Volume 11 - 2024 | doi: 10.3389/fmed.2024.1515263

The efficacy and safety of PD-1 inhibitors combined with chemotherapy treatment for advanced esophageal cancer: a network meta-analysis

Provisionally accepted
Jian-Zhou Tian Jian-Zhou Tian 1*Li Zhang Li Zhang 2*Fu-Yong Lin Fu-Yong Lin 3*Ren-jiao He Ren-jiao He 4*Wenrong Tian Wenrong Tian 3Liu Yan Liu Yan 3*Guoxin Huang Guoxin Huang 1Ai Jinwei Ai Jinwei 3*Bin Pei Bin Pei 1*De-sheng Li De-sheng Li 4*
  • 1 Evidence-Based Medicine Center, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
  • 2 Department of Central Sterile Supply, Fujian Medical University Union Hospital, Fuzhou, China
  • 3 Department of Plastic Surgery and Regenerative Medicine, Fujian Medical University Union Hospital, Fuzhou, China
  • 4 Department Three of Orthopedics/Plastic Surgery, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, China

The final, formatted version of the article will be published soon.

    This study systematically evaluated the efficacy of programmed death 1 (PD-1) inhibitors combined with chemotherapy for advanced esophageal cancer (EC). PubMed, Embase, Web of Science, Scopus, and Cochrane Library were searched to identify related randomized controlled trials (RCTs). Seven RCTs involving 4,363 participants were included. The results of the direct comparison showed that, compared with chemotherapy alone, PD-1 inhibitors combined with chemotherapy significantly improved overall survival (OS) (HR = 0.69, 95%CI = 0.63-0.74), progression-free survival (PFS) (HR = 0.63, 95%CI = 0.58-0.67), objective response rate (ORR) (RR = 1.41, 95%CI = 1.28-1.57), but were associated with a slight increase in treatment-related adverse events (AEs) (RR = 1.08, 95%CI = 1.03-1.14). The results of the network meta-analysis showed that toripalimab, sintilimab or camrelizumab, and nivolumab combined with chemotherapy were the best in OS, PFS, and ORR, respectively, with camrelizumab showing the lowest incidence of AEs. These results suggest that PD-1 inhibitors combined with chemotherapy provide superior clinical benefits over chemotherapy alone, albeit with a moderate increase in AEs. However, further verification through multi-center, high-quality RCTs with larger sample sizes is needed to confirm these findings.

    Keywords: Advanced esophageal cancer, PD-1 inhibitors, chemotherapy, combined therapy, Network meta-analysis

    Received: 22 Oct 2024; Accepted: 27 Dec 2024.

    Copyright: © 2024 Tian, Zhang, Lin, He, Tian, Yan, Huang, Jinwei, Pei and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Jian-Zhou Tian, Evidence-Based Medicine Center, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
    Li Zhang, Department of Central Sterile Supply, Fujian Medical University Union Hospital, Fuzhou, China
    Fu-Yong Lin, Department of Plastic Surgery and Regenerative Medicine, Fujian Medical University Union Hospital, Fuzhou, China
    Ren-jiao He, Department Three of Orthopedics/Plastic Surgery, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
    Liu Yan, Department of Plastic Surgery and Regenerative Medicine, Fujian Medical University Union Hospital, Fuzhou, China
    Ai Jinwei, Department of Plastic Surgery and Regenerative Medicine, Fujian Medical University Union Hospital, Fuzhou, China
    Bin Pei, Evidence-Based Medicine Center, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
    De-sheng Li, Department Three of Orthopedics/Plastic Surgery, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, China

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