A meta-analysis comparing responses of Asian versus non-Asian cancer patients to PD-1 and PD-L1 inhibitor-based therapy

Abstract

Background: Subgroup analysis of clinical trials of PD-1/PD-L1 inhibitors have reported ethnic differences in outcomes. We systematically collected published data and performed a meta-analysis to compare therapeutic efficacy in Asian and non-Asian patients receiving PD-1/PD-L1 inhibitors. Methods: Eligible studies included phase II and III prospective clinical trials with available subgroup data on Asian versus non-Asian populations. Overall survival (OS) and progression-free survival (PFS) were used to evaluate differences in outcome between Asian versus non-Asian cancer patients. Results: A total of 11,020 cancer patients from 19 prospective randomized controlled clinical trials were included. The overall estimated HR for OS was 0.69 with 95% CI of 0.61-0.77 in Asian versus 0.82 with 95% CI of 0.77-0.88 in non-Asian patients. The estimated hazard ratio (HR) for PFS measured 0.54 (95% CI, 0.32-0.76) and 0.69 (95% CI, 0.54-0.85) in Asian and non-Asian patients, respectively. Pooled ratios of OS HRs and PFS HRs reported in Asian versus non-Asian cancer patients were 0.84 (95% CI, 0.75-0.94) and 0.78 (95% CI, 0.59-0.97), respectively. Conclusions: This meta-analysis shows for the first time that Asian cancer patients have a significantly improved survival benefit than non-Asian patients receiving PD-1/PD-L1 inhibitor-based therapy.

Immune-Based Cancer Treatment: Addressing Disparities in Access and Outcomes

“…80 As a result, systematic reviews and meta-analyses have been performed to assess racial disparities in the pharmacokinetics, response, and adverse effects of immunotherapy. [81][82][83] Nevertheless, data are extremely limited, and clinical decisions for ethnic/racial minority groups are largely based on data extrapolated from non-Hispanic White populations. Regarding pharmacokinetics, two reports indicated no differences in clearance and predicted exposure between Asian and non-Asian patients in secondary analyses among those treated with nivolumab for non-small cell lung cancer/nasopharyngeal carcinoma and gastric/gastroesophageal junction carcinoma, respectively.…”

Plasma Gelsolin Confers Chemoresistance in Ovarian Cancer by Resetting the Relative Abundance and Function of Macrophage Subtypes

“…Interestingly, Asians with metastatic solid cancers other than OVCA receiving immunotherapy have significantly improved survival benefit compared with non-Asians, although the reason for the difference has not been investigated [ 8 ]. Plasma gelsolin has been shown to be a key factor in suppressing immune responses as well as chemosensitivity in OVCA patients from Western countries [ 9 , 10 ].…”

Immunotherapy Efficacy in the Initial Lines of Treatment in Advanced Upper Gastrointestinal Malignancies: A Systematic Review of the Literature

“…In the majority of studies analyzed, patients of Asian origin had better survival outcomes compared with non-Asian population ( 10 , 17 , 19 , 25 ), although this was not confirmed in the KEYNOTE-061 study ( 16 ). Cumulative evidence has indicated that Asian patients seem to gain more benefit when treated with anti-PD-1/PD-L1 ICI ( 42 ). Although the underlying mechanism to explain this difference remains unclear, some have suggested that this may be due to the difference in inter-population mutational profiles that could be related to IO response ( 43 ) or difference in clearance rates affecting the bioavailability of ICI in the body ( 44 ).…”