Prognostic and predictive factors in advanced upper gastrointestinal cancer treated with immune checkpoint inhibitors: a systematic review and meta-analysis of the current evidence.

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  • Additional Information
    • Source:
      Publisher: BioMed Central Country of Publication: England NLM ID: 100967800 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2407 (Electronic) Linking ISSN: 14712407 NLM ISO Abbreviation: BMC Cancer Subsets: MEDLINE
    • Publication Information:
      Original Publication: London : BioMed Central, [2001-
    • Subject Terms:
      Gastrointestinal Neoplasms*/drug therapy ; Gastrointestinal Neoplasms*/mortality ; Gastrointestinal Neoplasms*/pathology ; Gastrointestinal Neoplasms*/immunology ; Immune Checkpoint Inhibitors*/therapeutic use; Humans ; B7-H1 Antigen/antagonists & inhibitors ; Prognosis ; Progression-Free Survival
    • Abstract:
      Background: Immune checkpoint inhibitors (ICIs) have shown encouraging treatment efficacy for upper gastrointestinal cancers (UGICs). However, durable clinical responses only existed in a minority of patients. We evaluated evidence predicting survival benefits to identify the optimal population followed by ICI-based therapy.
      Methods: A comprehensive search was performed using PubMed, Embase, Cochrane Library, and Web of Science to identify clinical trials for UGICs with ICI-based therapy. The outcomes were objective response rate (ORR), progression-free survival (PFS), and overall survival (OS). The quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation System (GRADE).
      Results: Thirty-six studies comprising 12,440 patients were included for quantitative synthesis. Patients with PD-L1-positive (OR = 2.08, p < 0.00001), EBV+ (OR = 8.47, p = 0.003) tumors were more likely to respond to ICI treatment. Moreover, OS was significantly improved with the statistical subgroup difference concerning sex (p = 0.02) and region (p = 0.02). An exploratory subgroup analysis showed significantly improved OS with ICI plus chemotherapy in patients with CPS ≥ 10 (HR = 0.66, p = 0.001) and CPS ≥ 1 (HR = 0.75, p < 0.00001).
      Conclusion: UGIC patients with PD-L1-positive, EBV + status are associated with a better therapeutic response to ICI-based therapy. The male patients and Asian patients could derive more survival benefits following ICI treatment than female and non-Asian ones. A combination of prognostic and predictive factors was suggested to help guide immunotherapy decision-making in UGIC patients.
      (© 2024. The Author(s).)
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    • Grant Information:
      81803440 National Natural Science Foundation of China; 81803442 National Natural Science Foundation of China
    • Contributed Indexing:
      Keywords: Biomarker; Immune checkpoint inhibitor; Overall survival; Prognosis; Upper gastrointestinal cancer
    • Accession Number:
      0 (B7-H1 Antigen)
      0 (CD274 protein, human)
      0 (Immune Checkpoint Inhibitors)
    • Publication Date:
      Date Created: 20241009 Date Completed: 20241010 Latest Revision: 20241029
    • Publication Date:
      20241031
    • Accession Number:
      PMC11465923
    • Accession Number:
      10.1186/s12885-024-12998-w
    • Accession Number:
      39385078