PD-1 inhibitors combined with paclitaxel and cisplatin in first-line treatment of esophageal squamous cell carcinoma (ESCC): a network meta-analysis

Abstract

Abstract Background The combination of PD-1 inhibitors with paclitaxel/cisplatinum (PD-1 + TP) and fluoropyrimidine/cisplatinum (PD-1 + FP) both have been shown to improve overall survival (OS) and progression-free survival (PFS) in patients with previously untreated, advanced esophageal squamous cell carcinoma (ESCC). However, there is no consensus on which chemotherapy regimen combined with PD-1 has better efficacy. To address this important issue in the first-line treatment of patients with esophageal squamous cell carcinoma, we conducted a network meta-analysis. Methods Data were collected from eligible studies searched in Medline, Web of Science, Pubmed, the Cochrane Library and Embase. Pooled Hazard Ratio (HR) for OS, and PFS, Odds Ratio (OR) for objective response rate (ORR) and ≥ 3grade treatment-related adverse events (≥ 3TRAEs) were estimated to evaluate the efficacy of PD-1 inhibitors combined with TP or FP. Results Five RCTs and one retrospective study involving 3685 patients and evaluating 4 treatments were included in this network meta-analysis. Compared to other treatments, PD-1 + TP was better. For PFS, the HRs for PD-1 + TP compared to PD-1 + FP, TP and FP were 0.59 (0.44, 0.80), 0.56 (0.51, 0.61) and 0.45 (0.37, 0.56) respectively. For OS, PD-1 + TP was also a better treatment compared to other treatments, the HRs were 0.74 (0.56, 0.96), 0.64 (0.57, 0.71), 0.53 (0.43, 0.67) respectively. For ORR, there was no significant difference between PD-1 + TP and PD-1 + FP, ORs were 1.2 (0.69, 2.11). Compare with TP and FP, PD-1 + TP has a obvious advantage, ORs were 2.5 (2.04, 3.04) and 2.95 (1.91, 4.63). For ≥ 3TRAEs, PD-1 + TP compared to other treatments, OR were 1.34 (0.74, 2.46) and 1.13 (0.92, 1.38) and 2.23 (1.35, 3.69). Conclusion PD-1 + TP significantly improved both PFS and OS compared to PD-1 + FP. Taking into account both efficacy and safety, PD-1 + TP may be a superior first-line treatment option for esophageal squamous cell carcinoma.