Immunotherapy Versus Chemotherapy as First-line Treatment for Advanced Urothelial Cancer: A Systematic Review and Meta-Analysis
A partir d'une revue systématique de la littérature publiée entre 2016 et 2021 (2 068 patients inclus dans 3 essais de phase III), cette méta-analyse compare l'efficacité, du point de vue de la survie globale, d'une immunothérapie de première ligne à base d'un seul agent par rapport à une chimiothérapie à base de sels de platine, chez des patients atteints d'un carcinome urothélial de stade avancé
Background : Pembrolizumab and atezolizumab have recently been approved for the first-line treatmentof patients with advanced urothelial carcinoma (aUC) who are not eligible for cisplatin-basedchemotherapy and whose tumors have high PD-L1 expression; however, the use of theseimmunotherapeutic agents relative to standard of care chemotherapy has ongoing concerns.The aim of this present study is to compare the effectiveness of single-agent immune-oncology(IO) compounds versus platinum-based chemotherapy in the first-line setting of aUC. Methods : A comprehensive search for phase III trials on IO versus chemotherapy was conductedin PubMed, EMBASE, Web of Science, and Scopus databases from 01/2016 to 05/2021. Analgorithm to obtain survival data from published Kaplan-Meier curves was used to reconstruct overall survival (OS) data. After demonstrating violation of the proportional hazardassumption, we used the difference in restricted mean survival time (
ΔRMST) to compare OS. Results
:
OS data from 2,068 individuals from 3 phase III trials investigating the role of IOvs chemotherapy were reconciled. Overall, patients receiving IO [n=1,013 (49%)] orchemotherapy [n=1,055 (51%)] had similar OS with a 24-month ΔRMST of -0.4 (95% CI: -1.1, 0.4; p=0.2) months. In the cisplatin-ineligible population, patients receiving IO [n=509(49%)] or chemotherapy [n=530 (51%)] had similar OS with a 24-month ΔRMST of 0.1 (95% CI: -0.9, 1.2; p=0.7) months. In the cisplatin-ineligible population with PD-L1-high tumors, patientsreceiving IO [n=226 (50%)] or chemotherapy [n=226 (50%)] had similar OS with a 24-month ΔRMST of 1.1 (95% CI: -0.5, 2.7; p=0.1) months. Conclusion
:
We found no OS benefit for patients treated with first-line immune checkpoint inhibitioncompared to chemotherapy among the overall population, cisplatin-ineligible patients,and PD-L1-high patients.