最近,对于晚期胃癌或胃食管结合部腺癌(GC/GEJC)患者,帕博利珠单抗联合化疗的治疗方案被认为是一种有希望的治疗方案.然而,pembrolizumab联合化疗的疗效和副作用仍然缺乏循证医学证据支持.因此,进行了荟萃分析以评估该热点问题.通过搜索PubMed,EMBASE,科克伦图书馆,WebofScience,在符合纳入标准的晚期GC/GEJC患者中,pembrolizumab联合化疗与化疗的随机临床研究均被纳入.对文献质量进行评价并提取数据。还使用相关软件对数据进行分析并得出结论。在筛选14015项研究后,4项研究符合荟萃分析的条件.与单纯化疗组比较,总生存期(OS)明显延长.在程序性细胞死亡配体1(PD-L1)联合阳性评分(CPS)≥1亚组和PD-L1CPS≥10亚组分析中,结果显示,与单纯化疗组相比,pembrolizumab联合化疗组的缓解率(RR)和完全缓解率(CR)均较高.CR没有显著差异,治疗相关的不良事件,两组之间死于药物相关事件和免疫介导事件。然而,效果事件,如治疗相关的不良事件导致停药,3~5例治疗相关不良事件以及免疫介导的不良事件和输注反应在帕博利珠单抗联合化疗组中更为常见.总之,目前的荟萃分析显示,在处理高级GC/GEJC时,pembrolizumab联合化疗比单独化疗提高了治疗效果,明显更长的OS证明了这一点。此外,PD-L1CPS≥1个亚组和PD-L1CPS≥10个亚组的患者由于RR和CR较高,似乎可从派博利珠单抗联合化疗治疗中获益.然而,副作用,如导致停药的治疗相关不良事件,3-5个治疗相关的不良事件,免疫介导的不良事件和输液反应值得更多关注。
Recently, the treatment plan of
pembrolizumab plus chemotherapy was regarded as a promising treatment for patients with advanced gastric cancer or gastroesophageal junction adenocarcinoma (GC/GEJC). However, the efficacy and side effects of
pembrolizumab plus chemotherapy still lack evidence-based medical evidence to support. Therefore, a meta-analysis was conducted to evaluate the hot issue. By searching PubMed, EMBASE, Cochrane Library, Web of Science, any randomized clinical studies of
pembrolizumab plus chemotherapy versus chemotherapy in patients with advanced GC/GEJC met the inclusion criteria were included. The quality of the literature was evaluated and the data was extracted. A correlative software was also used to analyze the data and to draw a conclusion. After screening 14,015 studies, four studies were eligible for the meta-analysis. Compared with chemotherapy alone group, the overall survival (OS) rate was significantly longer. In programmed cell death ligand 1 (PD-L1) combined positive score (CPS) ≥1 subgroup and PD-L1 CPS ≥10 subgroup analyses, the results showed that the response rate (RR) and complete response rate (CR) were both higher in
pembrolizumab plus chemotherapy group compared with chemotherapy alone group. There were not significant differences in the CR, the treatment-related adverse events, succumbed to drug-related events and succumbed to immune-mediated events between the two groups. However, the effect events such as the treatment-related adverse events led to discontinuation, the 3-5 treatment-related adverse events and the immune-mediated adverse events and infusion reactions were more common in pembrolizumab plus chemotherapy group. In conclusion, the current meta-analysis revealed that, in treating advanced GC/GEJC,
pembrolizumab plus chemotherapy had improved therapeutic efficacies than chemotherapy alone, as evidenced by the significantly longer OS. Furthermore, the patients in PD-L1 CPS ≥1 subgroup and PD-L1 CPS ≥10 subgroup appeared to benefit from pembrolizumab plus chemotherapy treatment because of higher RR and CR. However, side effects such as the treatment-related adverse events leading to discontinuation, the 3-5 treatment-related adverse events, and immune-mediated adverse events and infusion reactions deserved more attention.