Efficacy and Safety of Immune Checkpoint Inhibitors for Recurrent or Metastatic Cervical Cancer: A Systematic Review and Meta-Analysis.
TL;DR
The findings indicate that immune checkpoint inhibitors represent a potentially effective treatment option for patients with cervical cancer; however, their safety profile warrants careful consideration.
Abstract
Background
Cervical cancer is a major global health challenge and requires the exploration of novel treatment strategies. Immune checkpoint inhibitors, particularly those targeting Programmed Death 1 (PD-1) and Programmed Death-Ligand 1 (PD-L1), have emerged as promising therapeutic agents in oncology. This study aimed to evaluate the efficacy and safety of these inhibitors in the treatment of cervical cancer.
Methods
A comprehensive literature search was conducted across PubMed, Embase, Web of Science, Scopus, the Cochrane Library, and the China National Knowledge Infrastructure to identify studies published up to November 1, 2024. A total of 26 relevant studies were included, including 21 Non-Randomized Controlled Trials (Non-RCTs) and 5 Randomized Controlled Trials (RCTs). The analysis primarily evaluated the efficacy and safety of PD-1/PD-L1 inhibitors in patients with advanced cervical cancer. The primary outcomes included the objective response rate, disease control rate, progression-free survival, overall survival, and adverse events. Non-RCTs and RCTs were evaluated using ROBINS-I and ROB 2, respectively. Data analysis and visualization were performed using STATA 17.0 and GraphPad. This study has been registered with PROSPERO (registration number CRD42024510357).
Results
Therapeutic outcomes indicated that the objective response rate in patients with cervical cancer was 44.30% (95% CI 31.06%-57.93%), and the disease control rate was 63.05% (95% CI 51.67%-73.78%). The complete response, partial response, stable disease, and progressive disease rates were 12.58% (95% CI 6.46%-20.13%), 26.87% (95% CI 19.92%-34.40%), 17.95% (95% CI 12.50%-24.07%), and 27.61% (95% CI 17.68%-38.71%), respectively. The median PFS was 6.22 months (95% CI 3.86-8.59), with 6- and 12-month PFS rates of 58.93% (95% CI 47.78%-69.65%) and 45.20% (95% CI 32.73%-57.96%), respectively. The median OS was 14.81 months (95% CI 8.45-21.16), with 6- and 12-month OS rates of 86.57% (95% CI 80.92%-91.42%) and 70.34% (95% CI 61.47%-78.53%), respectively. Regarding safety, the incidence of treatment-related adverse events was 83.24% (95% CI 73.93%-90.94%), serious adverse events was 25.71% (95% CI 15.33%-37.58%), adverse drug reactions was 71.57% (95% CI 57.61%-83.78%), and immunerelated adverse events was 34.26% (95% CI 27.11%-41.76%). Common treatment-related adverse events included anemia, diarrhea, nausea, and leukopenia.
Conclusion
The findings indicate that immune checkpoint inhibitors represent a potentially effective treatment option for patients with cervical cancer; however, their safety profile warrants careful consideration. Combination therapies involving PD-1 inhibitors appear to improve efficacy while maintaining manageable safety.