Immunotherapy-based regiments have potential as first-line treatment for advanced gastric esophageal cancer. The present study aimed to conduct a meta-analysis of the association between the efficacy and safety of first-line immunotherapy combined with chemotherapy in patients with unresectable locally advanced or metastatic gastric esophageal cancer. Subgroup analysis of patients with programmed death ligand 1 (PD-L1) combined positive score (CPS) was conducted to identify the characteristics of patients with immune benefit and to provide a decision-making basis for clinical practice. PubMed, Embase, Cochrane Library and other databases were searched to collect randomized controlled trials of immunotreatment-based regimens (experimental group) versus conventional first-line chemotherapy regimens (control group) for unresectable locally advanced or metastatic gastric esophageal cancer. The main outcome measures included progression-free survival (PFS), overall survival (OS), objective response rate, disease control rate and safety, and the secondary outcomes were the differences in OS and PFS between patients with PD-L1 CPS ≥10 and those with PD-L1 CPS <10. In addition, Asian and non-Asian populations were analysed. Nine studies with a total of 6,820 patients were included. The OS of patients treated with immunotherapy-based regimens was significantly longer than that of those treated with chemotherapy alone [HR=0.74; 95% CI (0.69, 0.80); P<0.00001]. The OS of patients with PD-L1 CPS ≥10 and PD-L1 CPS <10 in the experimental group was significantly longer than that of patients in the control group [HR=0.68; 95% CI (0.59, 0.77); P<0.00001 and HR=0.73; 95% CI (0.62, 0.87); P=0.0005]. The PFS of patients being treated with immunotherapy-based regimens was significantly longer than that of those treated with chemotherapy alone [HR=0.71; 95% CI (0.59, 0.86); P=0.0003]. In addition, the PFS of patients with PD-L1 CPS ≥10 and PD-L1 CPS <10 in the experimental group was significantly longer than that of patients in the control group [HR= 0.67; 95% CI (0.49, 0.92); P= 0.01 and HR= 0.63; 95% CI (0.48, 0.83); P= 0.001]. There was no significant difference in the overall incidence of adverse events and the incidence of grade 3 or above adverse events between the experimental and control groups [RR=1; 95% CI (0.99, 1.02); P= 0.65 and RR= 0.97; 95% CI (0.84, 1.12); P= 0.69, respectively]. In conclusion, treatment with immunotherapy-based regimens may prolong the OS of patients with unresectable locally advanced or metastatic gastric esophageal cancer and this treatment regimen is safe compared with chemotherapy alone.
Background Recent clinical trials have illustrated the superior efficacy and safety of sintilimab plus chemotherapy compared to chemotherapy alone in patients with advanced oesophageal squamous cell carcinoma. Aim This study aimed to evaluate the cost-effectiveness of sintilimab combined with chemotherapy vs. Chemotherapy alone as first-line treatment for advanced oesophageal squamous cell carcinoma patients in China. Method A partitioned survival model was developed to compare the lifetime costs and quality-adjusted life years of different treatment regimens. Sensitivity analysis was conducted to verify the robustness of the model results. Results Compared with chemotherapy alone, the sintilimab combination strategy resulted in an additional 0.58 quality-adjusted life years. The incremental cost-effectiveness ratio was $14,967.31/quality-adjusted life years, lowering the willingness-to-pay threshold ($37,663.26). Subgroup analysis demonstrated that sintilimab + chemotherapy was more cost-effective for patients with PD-L1 CPS ≥ 10. Sensitivity analysis confirmed the base-case analysis results. Conclusion The sintilimab combination strategy is a cost-effective option for first-line treatment of advanced oesophageal squamous cell carcinoma patients in China.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.