Efficacy and toxicity of immune checkpoint inhibitors combination therapy for advanced renal cell carcinoma: a systematic review and network meta-analysis
BackgroundAlthough immune checkpoint inhibitors (ICIs) show a significant overall survival advantage over standard advanced renal cell carcinoma (aRCC) therapies, tumor response to these agents remains poor. Some studies have shown that combination therapy including an ICI appears to be the best tre...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2024-02-01
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| Series: | Frontiers in Immunology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2024.1255577/full |
| _version_ | 1797320989419241472 |
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| author | Xiangyu Chen Zhunan Xu Changgui Wu Lijun Xie Pengyu Wang Xiaoqiang Liu |
| author_facet | Xiangyu Chen Zhunan Xu Changgui Wu Lijun Xie Pengyu Wang Xiaoqiang Liu |
| author_sort | Xiangyu Chen |
| collection | DOAJ |
| description | BackgroundAlthough immune checkpoint inhibitors (ICIs) show a significant overall survival advantage over standard advanced renal cell carcinoma (aRCC) therapies, tumor response to these agents remains poor. Some studies have shown that combination therapy including an ICI appears to be the best treatment; however, the overall benefit in terms of efficacy and toxicity still needs to be assessed. Thus, we performed a network meta-analysis to evaluate the differences in the efficacy of several combinations that include an ICI to provide a basis for clinical treatment selection.MethodsWe conducted a thorough search of PubMed, EMBASE, and the Cochrane Library for articles from January 2010 to June 2023. R 4.4.2 and STATA 16.0 were used to analyze data; hazard ratio (HR) and odds ratio (OR) with 95% confidence intervals (CI) were used to assess the results.ResultsAn indirect comparison showed that nivolumab plus cabozantinib and pembrolizumab plus lenvatinib were the most effective treatments for progression-free survival (PFS), with no significant differences between the two interventions (HR, 1.31; 95% CI, 0.96–1.78; P=0.08); rank probability showed that pembrolizumab plus lenvatinib had a 57.1% chance of being the preferred treatment. In the absence of indirect comparisons between pembrolizumab plus axitinib, nivolumab plus ipilimumab, avelumab plus axitinib, nivolumab plus cabozantinib, and pembrolizumab plus lenvatinib, pembrolizumab plus axitinib (40.2%) was the best treatment option for overall survival (OS). Compared to pembrolizumab plus lenvatinib, nivolumab plus ipilimumab (OR, 0.07; 95% CI, 0.01–0.65; P=0.02) and pembrolizumab plus axitinib (OR, 0.05; 95% CI, 0.00–0.78; P<0.001) had a lower incidence of overall adverse events (AEs).ConclusionPembrolizumab plus lenvatinib and pembrolizumab plus axitinib resulted in the highest PFS and OS rates, respectively. Pembrolizumab plus axitinib may be the best option when AEs are a concern.Systematic review registrationhttps://inplasy.com/, identifier INPLASY202410078. |
| first_indexed | 2024-03-08T04:51:02Z |
| format | Article |
| id | doaj.art-d82ce00b18044a12a29d2edd2ff933b0 |
| institution | Directory Open Access Journal |
| issn | 1664-3224 |
| language | English |
| last_indexed | 2024-03-08T04:51:02Z |
| publishDate | 2024-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Immunology |
| spelling | doaj.art-d82ce00b18044a12a29d2edd2ff933b02024-02-08T05:11:29ZengFrontiers Media S.A.Frontiers in Immunology1664-32242024-02-011510.3389/fimmu.2024.12555771255577Efficacy and toxicity of immune checkpoint inhibitors combination therapy for advanced renal cell carcinoma: a systematic review and network meta-analysisXiangyu ChenZhunan XuChanggui WuLijun XiePengyu WangXiaoqiang LiuBackgroundAlthough immune checkpoint inhibitors (ICIs) show a significant overall survival advantage over standard advanced renal cell carcinoma (aRCC) therapies, tumor response to these agents remains poor. Some studies have shown that combination therapy including an ICI appears to be the best treatment; however, the overall benefit in terms of efficacy and toxicity still needs to be assessed. Thus, we performed a network meta-analysis to evaluate the differences in the efficacy of several combinations that include an ICI to provide a basis for clinical treatment selection.MethodsWe conducted a thorough search of PubMed, EMBASE, and the Cochrane Library for articles from January 2010 to June 2023. R 4.4.2 and STATA 16.0 were used to analyze data; hazard ratio (HR) and odds ratio (OR) with 95% confidence intervals (CI) were used to assess the results.ResultsAn indirect comparison showed that nivolumab plus cabozantinib and pembrolizumab plus lenvatinib were the most effective treatments for progression-free survival (PFS), with no significant differences between the two interventions (HR, 1.31; 95% CI, 0.96–1.78; P=0.08); rank probability showed that pembrolizumab plus lenvatinib had a 57.1% chance of being the preferred treatment. In the absence of indirect comparisons between pembrolizumab plus axitinib, nivolumab plus ipilimumab, avelumab plus axitinib, nivolumab plus cabozantinib, and pembrolizumab plus lenvatinib, pembrolizumab plus axitinib (40.2%) was the best treatment option for overall survival (OS). Compared to pembrolizumab plus lenvatinib, nivolumab plus ipilimumab (OR, 0.07; 95% CI, 0.01–0.65; P=0.02) and pembrolizumab plus axitinib (OR, 0.05; 95% CI, 0.00–0.78; P<0.001) had a lower incidence of overall adverse events (AEs).ConclusionPembrolizumab plus lenvatinib and pembrolizumab plus axitinib resulted in the highest PFS and OS rates, respectively. Pembrolizumab plus axitinib may be the best option when AEs are a concern.Systematic review registrationhttps://inplasy.com/, identifier INPLASY202410078.https://www.frontiersin.org/articles/10.3389/fimmu.2024.1255577/fullimmune checkpoint inhibitorstyrosine kinase inhibitorsadvanced renal cell carcinomacombination therapyefficacy |
| spellingShingle | Xiangyu Chen Zhunan Xu Changgui Wu Lijun Xie Pengyu Wang Xiaoqiang Liu Efficacy and toxicity of immune checkpoint inhibitors combination therapy for advanced renal cell carcinoma: a systematic review and network meta-analysis Frontiers in Immunology immune checkpoint inhibitors tyrosine kinase inhibitors advanced renal cell carcinoma combination therapy efficacy |
| title | Efficacy and toxicity of immune checkpoint inhibitors combination therapy for advanced renal cell carcinoma: a systematic review and network meta-analysis |
| title_full | Efficacy and toxicity of immune checkpoint inhibitors combination therapy for advanced renal cell carcinoma: a systematic review and network meta-analysis |
| title_fullStr | Efficacy and toxicity of immune checkpoint inhibitors combination therapy for advanced renal cell carcinoma: a systematic review and network meta-analysis |
| title_full_unstemmed | Efficacy and toxicity of immune checkpoint inhibitors combination therapy for advanced renal cell carcinoma: a systematic review and network meta-analysis |
| title_short | Efficacy and toxicity of immune checkpoint inhibitors combination therapy for advanced renal cell carcinoma: a systematic review and network meta-analysis |
| title_sort | efficacy and toxicity of immune checkpoint inhibitors combination therapy for advanced renal cell carcinoma a systematic review and network meta analysis |
| topic | immune checkpoint inhibitors tyrosine kinase inhibitors advanced renal cell carcinoma combination therapy efficacy |
| url | https://www.frontiersin.org/articles/10.3389/fimmu.2024.1255577/full |
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