PD-1 inhibitors outperform chemo in second-line treatment of advanced oesophageal cancer

In the second-line treatment of patients advanced oesophageal cancer (AEC), the use of programmed cell death 1 (PD-1) inhibitors yields more favourable outcomes than chemotherapy across multiple patient subgroups, according to the results of a meta-analysis.

Researchers accessed multiple online databases and performed a systematic review of studies that evaluated the efficacy and tolerability of PD-1/programmed cell death ligand 1 (PD-L1) inhibitors relative to chemotherapy for AEC patients who progressed after first-line therapy.

Four randomized controlled trials involving a total of 1,683 AEC patients met the eligibility criteria. Pooled data indicated that compared with chemotherapy, the use of PD-1 inhibitors in the second-line setting prolonged the overall survival (OS; hazard ratio [HR], 0.79, 95 percent confidence interval [CI], 0.71–0.88; p<0.01) and increased the objective response rate (ORR; risk ratio [RR], 3.00, 95 percent CI, 2.36–3.82; p=0.01). However, there was no significant improvement noted in progression-free survival (PFS; HR, 0.96, 95 percent CI, 0.76–1.20; p=0.692).

Relative to chemotherapy, PD-1 inhibitors alone were also safer, being associated with lower incidences of all treatment-related adverse events (AEs; OR, 0.29, 95 percent CI, 0.09–0.89; p=0.03) and high-grade treatment-related AEs (grade 3–5; OR, 0.26, 95 percent CI, 0.16–0.44; p<0.01).

The OS benefit of PD-1 inhibitors was pronounced in men, patients aged <65 years, those with Eastern Cooperative Oncology Group performance status of 1, and those with PD-L1 tumour proportion score of ≥10 percent. Furthermore, Asian patients had a longer OS with PD-1 inhibitors compared with non-Asian patients (p=0.01).