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Archive > Volume 30 Issue 5 > 2023,30(5):393-400. DOI:10.3872/j.issn.1007-385X.2023.05.005 Prev Next
Clinical Research
Efficacy and safety of PD-1/PD-L1 inhibitors-based immunocombination therapy versus sunitinib in the treatment of advanced renal cell carcinoma: a Meta-analysis
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Abstract:
Objective: To systematically evaluate the safety and efficacy of PD-1/PD-L1 inhibitor-based immunotherapy (hereinafter referred to as "combination immunotherapy") compared with sunitinib in the treatment of advanced renal cell carcinoma (RCC). Methods: Databases such as PubMed, Embase, Cochrane Library, and CNKI were searched from the date of their establishment to October 2022 to collect the randomized controlled trials (RCTs) of combination immunotherapy versus sunitinib for the treatment of advanced renal cell carcinoma (RCC).Two reviewers independently evaluated the quality of included studies, extracted data, and cross-checked the information. Meta-analysis was performed using StataMP16.0 software. Results: A total of 6 RCTs were included. The results of the Meta-analysis showed that: (1)Effectiveness. Compared to sunitinib, combination immunotherapy significantly improved overall survival (HR=0.74, 95% CI [0.67, 0.80], P<0.01) and progression-free survival (HR=0.66, 95% CI [0.51, 0.81], P<0.01) in patients with advanced RCC. (2) Safety. Both groups had comparatively high incidences of adverse events (AEs) but the difference was not significant between the two arms. However, the AEs of the skin and endocrine system in the combination immunotherapy arm were significantly higher than those of the sunitinib arm, while the AEs of the blood system were significantly lower than those of the sunitinib arm. (3) No matter the expression of PD-L1 in RCC patients was negative or positive (1% as the Cut-off value), the OS and PFS of patients treated with combination immunotherapy were higher than those treated with sunitinib. Conclusion: Combined immunotherapy can significantly prolong the OS and PFS of patients with advanced RCC, but the incidence of AEs in different systems is different, and the expression of PD-L1 in RCC patients (with 1% as the Cut-off value) does not affect the benefit of combination immunotherapy.
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