Clinical efficacy and safety of anti PD 1/PD L1 inhibitors for the treatment of advanced or metastatic cancer: a systematic review and meta analysis
Anti PD 1/PD L1 inhibitors provide a survival advantage over conventional therapies for treatment of advanced or metastatic cancer. However, the factors determining which patients benefit the most from anti PD 1/PD L1 inhibitors are unknown, making treatment related decisions difficult. We performed a systematic review and meta analysis of acquired data to assess the efficacy and toxicity of anti PD 1/PD L1 inhibitors in advanced and metastatic cancer. A thorough search strategy was applied to identify randomised controlled trials (RCTs) in Pubmed, Embase, Cochrane, and major conferences. Studies meeting predefined selection criteria were selected, and two independent investigators performed data extraction; overall survival (OS) progression free survival (PFS) and overall response rate were compared between anti PD 1/PD L1 inhibitors and control therapies. We calculated the pooled response rate and 95% CIs of all grade and high grade =3) adverse effects and evaluated the within study heterogeneity using subgroup, sensitivity, and meta regression analyses. In final, we included eligible 35 RCTs (21047 patients) The main estimated hazard ratios (HRs) for OS and PFS were 0.76 (0.71 0.82) and 0.81 (0.73 0.89) in a random effects model. The anti PD 1/PD L1 inhibitor group had a significantly high risk for all grade immune related adverse events. Anti PD 1/PD L1 inhibitors were identified as a preferable treatment option for advanced or metastatic cancer patients who are male, aged 65 years, current or former smokers, had no CNS or liver metastasis, had not EGFR mutation, and had high PD L1 expression.
Scientific Reports