背景:肛门鳞状细胞癌(SCCA)是一种罕见的肿瘤。虽然大多数局部晚期疾病的患者可以通过化疗治愈,大约四分之一的患者最终出现转移性复发.晚期疾病的标准治疗方法是化疗,但最近有关于免疫治疗活性的证据报道。我们对SCCA患者免疫检查点抑制剂(ICIs)的前瞻性试验进行了系统评价和荟萃分析。
目的:我们旨在评估晚期SCCA患者ICI的总体缓解率(ORR)和疾病控制率(DCR)。
方法:我们系统地搜索了PubMed,Embase,还有Scopus,至2022年12月31日,用于评估晚期SCCA患者ICI的前瞻性试验。主要终点和次要终点分别为ORR和DCR。
结果:六项前瞻性试验纳入分析,其中一个是随机的。总的来说,对7个治疗组和347名患者进行了分析。五个治疗组测试了ICIs作为单一疗法,两个组检查了ICIs与西妥昔单抗和贝伐单抗的组合,分别。合并的ORR为13%(95CI,10%-17%),DCR为57%(95CI,40%-74%)。敏感性分析结果没有变化,其中排除了测试ICIs与其他药物组合的两个治疗组。
结论:ICIs在SCCA中的疗效较低。与靶向药物或化疗的联合策略可能代表了这些患者更好的治疗策略。等待进一步的研究以确定对ICIs的抗性机制并优化其功效。
BACKGROUND: Squamous cell carcinoma of the anus (SCCA) is a rare tumor. While most patients with locally advanced disease are cured with chemo-radiotherapy, about a quarter eventually experience metastatic recurrence. Standard treatment for advanced disease is chemotherapy, but recently evidence on the activity of immunotherapy has been reported. We performed a systematic
review and meta-analysis of prospective trials testing immune-checkpoint inhibitors (ICIs) in patients with SCCA.
OBJECTIVE: We aimed to evaluate the overall response rate (ORR) and the disease control rate (DCR) of ICIs in patients with advanced SCCA.
METHODS: We systematically searched PubMed, Embase, and Scopus, through December 31, 2022, for prospective trials assessing ICIs in patients with advanced SCCA. The primary and secondary endpoints were respectively ORR and DCR.
RESULTS: Six prospective trials were included in the analysis, one of which was randomized. Overall, seven treatment arms and 347 patients have been analyzed. Five treatment arms tested ICIs as monotherapy and two arms examined ICIs in combination with cetuximab and bevacizumab, respectively. The pooled ORR was 13% (95%CI, 10%-17%), with a DCR of 57% (95%CI, 40%-74%). Results did not change in a sensitivity analysis, which excluded the two treatment arms testing the combination of ICIs with other drugs.
CONCLUSIONS: The efficacy of ICIs in SCCAs is low. Combination strategies with targeted drugs or chemotherapy might represent a better therapeutic strategy for these patients. Further studies are awaited to identify resistance mechanisms to ICIs and optimize their efficacy.