PD-1/PD-L1抑制剂单药治疗与联合PARP抑制剂或抗血管生成药物治疗晚期或复发性子宫内膜癌的疗效比较：一项系统评价和网状Meta分析
Efficacy comparison of PD-1/PD-L1 inhibitor monotherapy and combination with PARPis or antiangiogenic agents in advanced or recurrent endometrial cancer: a systematic review and network meta-analysis.
作者信息
Ji Shiya, Chen Xupeng, Yu Yebo, Jia Qiuping, Zhang Xingxing, Gao Zixin
机构信息
Department of Health Education, Nanjing Municipal Center for Disease Control and Prevention, No.16 Kunlun Road, Nanjing, 210003, Jiangsu Province, China.
Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China.
出版信息
BMC Womens Health. 2025 Feb 28;25(1):93. doi: 10.1186/s12905-025-03612-7.
PURPOSE
The network meta-analysis (NMA) was aimed to compare and assess the effectiveness of programmed cell death 1 (PD-1)/ programmed cell death ligand 1 (PD-L1) inhibitor monotherapy or combination therapy with other agents for individuals with advanced or recurrent endometrial cancer (EC).
METHODS
The NMA was registered on the PROSPERO website (ID: CRD42024545968) and multiple databases were queried to retrieve the articles. It assessed the progression-free survival (PFS) and overall survival (OS) of persons with advanced or recurrent EC, as well as those with deficient mismatch repair (dMMR) and proficient mismatch repair (pMMR) in terms of PFS.
RESULTS
The NMA included 12 studies involving a total of 4,515 patients. Compared to chemotherapy, the PD-1/PD-L1 inhibitor monotherapy (hazard ratio [HR], 0.59; 95% confidence interval [CI]: 0.44-0.78) in PFS, combination therapy with poly (ADP-ribose) polymerase inhibitors (PARPis) (HR, 0.53; 95% CI: 0.32-0.89) or with antiangiogenic agents (HR, 0.48; 95% CI: 0.25-0.83) all showed significant improvements in PFS. PD-1/PD-L1 inhibitor monotherapy resulted in a significantly higher OS (HR, 0.61; 95% CI: 0.37-0.97) compared to chemotherapy. Combination therapy with antiangiogenic agents demonstrated the highest efficacy in extending PFS, while the combination with PARPis had the best performance in extending OS. Patients with dMMR and pMMR subtypes derive greater benefits from PD-1/ PD-L1 inhibitor monotherapy and PD-1/PD-L1 inhibitors combined with PARPis respectively.
CONCLUSION
Monotherapy with PD-1/PD-L1 inhibitors and combination therapies with PARPis or antiangiogenic agents demonstrate significant potential for individuals with advanced or recurrent EC.
目的
网络荟萃分析（NMA）旨在比较和评估程序性细胞死亡蛋白1（PD-1）/程序性细胞死亡配体1（PD-L1）抑制剂单药治疗或与其他药物联合治疗晚期或复发性子宫内膜癌（EC）患者的有效性。
方法
该NMA在PROSPERO网站（ID：CRD42024545968）上注册，并查询多个数据库以检索文章。评估晚期或复发性EC患者的无进展生存期（PFS）和总生存期（OS），以及错配修复缺陷（dMMR）和错配修复 proficient（pMMR）患者的PFS。
结果
该NMA纳入了12项研究，共涉及4515例患者。与化疗相比，PD-1/PD-L1抑制剂单药治疗（风险比[HR]，0.59；95%置信区间[CI]：0.44-0.78）在PFS方面，与聚（ADP-核糖）聚合酶抑制剂（PARPis）联合治疗（HR，0.53；95%CI：0.32-0.89）或与抗血管生成药物联合治疗（HR，0.48；95%CI：0.25-0.83）在PFS方面均显示出显著改善。与化疗相比，PD-1/PD-L1抑制剂单药治疗导致OS显著更高（HR，0.61；95%CI：0.37-0.97）。与抗血管生成药物联合治疗在延长PFS方面显示出最高疗效，而与PARPis联合治疗在延长OS方面表现最佳。dMMR和pMMR亚型患者分别从PD-1/PD-L1抑制剂单药治疗和PD-1/PD-L1抑制剂与PARPis联合治疗中获益更大。
结论
PD-1/PD-L1抑制剂单药治疗以及与PARPis或抗血管生成药物联合治疗对晚期或复发性EC患者显示出显著潜力。
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