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

作     者：Longkun Mao Meihua Yang Xinxiang Fan Wenjie Li Xiaodong Huang Wang He Tianxin Lin Jian Huang 

作者机构：Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene RegulationMedical Research CenterSun Yat-Sen Memorial HospitalSun Yat-Sen(Zhongshan)UniversityGuangzhouChina Department of UrologySun Yat-sen Memorial HospitalSun Yat-sen(Zhongshan)UniversityGuangzhouChina Guangdong Provincial Clinical Research Center for Urological DiseasesGuangzhouChina The First Affiliated Hospital of Nanchang UniversityNanchangChina 

出 版 物：《Cancer Innovation》 (肿瘤创新（英文）)

年 卷 期：2023年第2卷第3期

页      面：191-202页

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

基　　金：Guangdong Province Higher Vocational Colleges&Schools Pearl River Scholar Funded Scheme Science and Technology Planning Project of Guangdong Province,Grant/Award Number:2017B020227007 Guangdong Provincial Clinical Research Center for Urological Diseases,Grant/Award Number:2020B1111170006 National Natural Science Foundation of China,Grant/Award Numbers:81825016,81772719,8217326,81772728,819723856,81961128027,82002679 National Key Research and Development Program of China,Grant/Award Number:2018YFA0902803 Key Areas Research and Development Program of Guangdong,Grant/Award Number:2018B010109006 Key Laboratory of Malignant Tumor 

主　　题：chemotherapy efficacy immune checkpoint inhibitors safety urinary bladder neoplasms 

摘      要：Background:Programmed cell death-1/ligand 1 inhibitors are a new treatment strategy for advanced urothelial ***,a comparative evaluation of their efficacy and toxicity compared with chemotherapy is ***:We comprehensively searched PubMed,Web of Science,Embase,and Cochrane Library databases and performed a meta-analysis of randomized controlled trials up to July *** considered overall survival as the primary outcome,and progression-free survival,objective response rate,and treatment-related adverse events as secondary ***:Overall,3584 patients from five studies were *** with first-line chemotherapy,programmed cell death-1/ligand 1 inhibitors were significantly associated with worse progression-free survival(p0.001)and adverse objective response rates(p0.001).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(p0.001),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:p0.001;second-line chemotherapy:p0.001).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.