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Cancer Innovation 2023, 2(3): 191-202 https://doi.org/10.1002/cai2.75
Meta-analysis | Open Access | Issue | Published: 19 May 2023

PD‐1/L1 inhibitors can improve but not replace chemotherapy for advanced urothelial carcinoma: A systematic review and network meta‐analysis

Show Author's Information Longkun Mao1,2,3,  Meihua Yang2,4,  Xinxiang Fan1,2,3,  Wenjie Li1,2,3,  Xiaodong Huang1,2,3,  Wang He1,2,3,  Tianxin Lin1,2,3 ( ),  Jian Huang1,2,3( )
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat‐Sen Memorial Hospital, Sun Yat‐Sen (Zhongshan) University, Guangzhou, China
Department of Urology, Sun Yat‐sen Memorial Hospital, Sun Yat‐sen (Zhongshan) University, Guangzhou, China
Guangdong Provincial Clinical Research Center for Urological Diseases, Guangzhou, China
The First Affiliated Hospital of Nanchang University, Nanchang, China
Keywords:
safety, chemotherapy, efficacy, immune checkpoint inhibitors, urinary bladder neoplasms
Cite this article:
Mao L, Yang M, Fan X, et al. PD‐1/L1 inhibitors can improve but not replace chemotherapy for advanced urothelial carcinoma: A systematic review and network meta‐analysis. Cancer Innovation, 2023, 2(3): 191-202. https://doi.org/10.1002/cai2.75
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Abstract Full text About this article
Background

Programmed cell death‐1/ligand 1 inhibitors are a new treatment strategy for advanced urothelial carcinoma. Therefore, a comparative evaluation of their efficacy and toxicity compared with chemotherapy is necessary.

Methods

We comprehensively searched PubMed, Web of Science, Embase, and Cochrane Library databases and performed a meta‐analysis of randomized controlled trials up to July 2021. We considered overall survival as the primary outcome, and progression‐free survival, objective response rate, and treatment‐related adverse events as secondary outcomes.

Results

Overall, 3584 patients from five studies were evaluated. Compared with first‐line chemotherapy, programmed cell death‐1/ligand 1 inhibitors were significantly associated with worse progression‐free survival (p < 0.001) and adverse objective response rates (p < 0.001). However, the treatments were not significantly different in terms of overall survival (p = 0.33). Compared with second‐line chemotherapy, programmed cell death‐1/ligand 1 inhibitors significantly improved overall survival (p < 0.001), and there was no statistically significant difference in progression‐free survival (p = 0.89) or objective response rate (p = 0.34). Compared with chemotherapy, programmed cell death‐1/ligand 1 inhibitors were well tolerated (first‐line chemotherapy: p < 0.001; second‐line chemotherapy: p < 0.001).

Conclusions

The efficacy of programmed cell death‐1/ligand 1 inhibitors in patients with advanced urothelial carcinoma is not superior to that of first‐line platinum‐based chemotherapy but is better than second‐line chemotherapy; however, programmed cell death‐1/ligand 1 inhibitors are safer than first‐ and second‐line chemotherapy and have a broader prospect for use in combination therapy.


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Abstract
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About this article

PD‐1/L1 inhibitors can improve but not replace chemotherapy for advanced urothelial carcinoma: A systematic review and network meta‐analysis

Show Author's information Longkun Mao1,2,3, Meihua Yang2,4, Xinxiang Fan1,2,3, Wenjie Li1,2,3, Xiaodong Huang1,2,3, Wang He1,2,3, Tianxin Lin1,2,3 ( ), Jian Huang1,2,3( )
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat‐Sen Memorial Hospital, Sun Yat‐Sen (Zhongshan) University, Guangzhou, China
Department of Urology, Sun Yat‐sen Memorial Hospital, Sun Yat‐sen (Zhongshan) University, Guangzhou, China
Guangdong Provincial Clinical Research Center for Urological Diseases, Guangzhou, China
The First Affiliated Hospital of Nanchang University, Nanchang, China

Abstract

Background

Programmed cell death‐1/ligand 1 inhibitors are a new treatment strategy for advanced urothelial carcinoma. Therefore, a comparative evaluation of their efficacy and toxicity compared with chemotherapy is necessary.

Methods

We comprehensively searched PubMed, Web of Science, Embase, and Cochrane Library databases and performed a meta‐analysis of randomized controlled trials up to July 2021. We considered overall survival as the primary outcome, and progression‐free survival, objective response rate, and treatment‐related adverse events as secondary outcomes.

Results

Overall, 3584 patients from five studies were evaluated. Compared with first‐line chemotherapy, programmed cell death‐1/ligand 1 inhibitors were significantly associated with worse progression‐free survival (p < 0.001) and adverse objective response rates (p < 0.001). However, the treatments were not significantly different in terms of overall survival (p = 0.33). Compared with second‐line chemotherapy, programmed cell death‐1/ligand 1 inhibitors significantly improved overall survival (p < 0.001), and there was no statistically significant difference in progression‐free survival (p = 0.89) or objective response rate (p = 0.34). Compared with chemotherapy, programmed cell death‐1/ligand 1 inhibitors were well tolerated (first‐line chemotherapy: p < 0.001; second‐line chemotherapy: p < 0.001).

Conclusions

The efficacy of programmed cell death‐1/ligand 1 inhibitors in patients with advanced urothelial carcinoma is not superior to that of first‐line platinum‐based chemotherapy but is better than second‐line chemotherapy; however, programmed cell death‐1/ligand 1 inhibitors are safer than first‐ and second‐line chemotherapy and have a broader prospect for use in combination therapy.

Keywords: safety, chemotherapy, efficacy, immune checkpoint inhibitors, urinary bladder neoplasms

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Received: 18 November 2022
Accepted: 02 April 2023
Published: 19 May 2023
Issue date: June 2023

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© 2023 The Authors. Tsinghua University Press.

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