Comparative efficacy and safety of immunotherapy for patients with advanced or metastatic esophageal squamous cell carcinoma: A network meta-analysis.

Abstract

e16079 Background: Integrating immune checkpoint inhibitors (ICIs) with conventional chemotherapy has significantly transformed oncology, creating new treatment standards for various cancers. This comprehensive network meta-analysis evaluates the efficacy and safety of various ICI and chemotherapy combinations in patients with esophageal squamous cell carcinoma (ESCC). Methods: This network meta-analysis adhered to PRISMA guidelines. We searched multiple databases for randomized controlled trials (RCTs) involving patients with advanced or metastatic ESCC who received at least one immune checkpoint inhibitor treatment. Thirteen RCTs encompassing 6907 patients met the inclusion criteria and were included in the analysis. Outcomes assessed overall survival (OS), progression-free survival (PFS), and treatment-related adverse events. Results: Combination therapies involving ICIs and chemotherapy generally outperformed chemotherapy alone. For overall survival, the NMA indicated that Cetuximab plus chemotherapy significantly reduced the risk of death at 6 months (HR = 0.3750, 95%CI [0.1676; 0.8389]; p-value = 0.0170), while Tislelizumab plus chemotherapy was most effective at 12 and 18 months in comparison to chemotherapy alone (HR = 0.6588, 95%CI [0.5581; 0.7776]; p-value < 0.0001) and (HR = 0.8114, 95%CI [0.7237; 0.9098]; p-value = 0.0003), respectively. At 24 months, Nivolumab plus Ipilimumab was most effective (HR = 0.8942, 95%CI [0.8442; 0.9472]; p-value = 0.0001). For PFS, Camrelizumab plus chemotherapy was most effective at 6 months (HR = 0.7610, 95%CI [0.6665; 0.8689] p-value < 0.0001), and Sintilimab plus chemotherapy at 12 months (HR = 0.8472, 95%CI [0.7946; 0.9032]; p-value < 0.0001). Pembrolizumab plus chemotherapy was most effective at 18 and 24 months (HR = 0.9087, 95%CI [0.8632; 0.9567]; p-value = 0.0003) and (HR = 0.9596, 95%CI [0.9328; 0.9871]; p-value = 0.0043), respectively. Safety profiles varied, with immune-related adverse events more common in treatments involving immune checkpoint inhibitors. Conclusions: Combination therapies with immune checkpoint inhibitors and chemotherapy improve survival in advanced or metastatic ESCC compared to chemotherapy alone. These findings support the use of novel immunotherapeutic agents to enhance patient outcomes, warranting further research to optimize treatment regimens and manage adverse events effectively.