Programmed Cell Death 1
Receptor / Programmed Death-Ligand1 (PD‐1/PD‐L1 ) Inhibitors Alone or
with Conventional Therapy versusStandard of Care for Head
and Neck Cancer: A Systematic Review and Meta-Analysis
Abstract :
ObjectivesAs a pivotal part of precision therapy, PD‐1/PD‐L1 immunotherapy has
been gradually used in head and neck cancer (HNC). We investigated the
effect and adverse events of PD‐1/PD‐L1 inhibitors alone or with
conventional therapy.
Design The groups using
PD-1/PD-L1 immunotherapy or combining with conventional therapy were
defined as the experimental groups, while the standard of care were the
control groups. Cochrane Library,
Embase, PubMed, and Web of Science were undertaken to identify
literature up to November 20, 2020. Overall survival (OS)
and progression-free survival
(PFS) were the primary outcome measures. Secondary outcome measures
included objective response rate (ORR), disease control rate (DCR), any
grade and grade≥3 adverse events (AE).
Results Five randomized
controlled trials (RCTs) and nine single-arm trials were included in the
systematic review. The OS of the experimental groups was better than the
control groups
(OR = 0.63,
95%CI: 0.49‐0.82, I²=35%, P=0.0004), particularly in patients who
smoke current/former or with human papillomavirus negative
(HPV- ). The experimental groups had longer OS
than the control groups in patients with PD-L1 positive (OR = 0.75, 95%
CI: 0.65‐0.85, I²=0%, P<0.0001). Patients with HPV positive
(HPV+) had more favorable OS than those with
HPV- (OR = 0.56, 95%CI:0.44-0.71, I²=39%,
P<0.00001). There were statistical differences in AEs (e.g.,
fatigue, rash, hypothyroidism, etc.) and no
statistical
differences in PFS, ORR, and DCR.
Conclusion PD-1/PD-L1 immunotherapy or combining with
conventional therapy can improve the treatment effect and induce fewer
adverse events of digestion and blood system, except for hypothyroidism.
Key points PD-1/PD-L1 inhibitors alone or with conventional
therapy can improve OS; patients with PD-L1 combined positive score
(CPS) >1 were more suitable for PD-1/PD-L1 inhibitors, and
HPV positive patients had a more favorable OS; higher risk of
hypothyroidism in PD-1/PD-L1 inhibitors; OS of patients with HPV
negative and smoke current/former in PD-1/PD-L1 inhibitors are better
than Standard of Care; Fewer adverse events of PD-1/PD-L1 inhibitors
both any grade and grade≥3 (e.g., nausea, decreased appetite, anemia,
etc.).
PROSPERO (CRD42020223177)
Keywords : head and neck
cancer, immune checkpoint inhibitors, Programmed Cell Death 1 Receptor
(PD-1), Programmed Death-Ligand1 (PD‐L1), human papillomavirus,
immunotherapy