Angelina Tjokrowidjaja, Peey-Sei Kok, Yoland C Antill, Clare L Scott, Linda R Mileshkin, Michael L Friedlander, Chee K Lee
{"title":"化疗对错配修复缺陷晚期子宫内膜癌患者的影响--一项荟萃分析。","authors":"Angelina Tjokrowidjaja, Peey-Sei Kok, Yoland C Antill, Clare L Scott, Linda R Mileshkin, Michael L Friedlander, Chee K Lee","doi":"10.1093/jncics/pkae101","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Chemo-immunotherapy is standard of care for women with recurrent or advanced mismatch repair deficient endometrial carcinoma. However, it is uncertain whether patients with mismatch repair deficient advanced or recurrent endometrial carcinoma derive less benefit from chemotherapy than those with mismatch repair proficient endometrial carcinoma.</p><p><strong>Methods: </strong>We performed a meta-analysis of randomized controlled trials (RCTs) in advanced or recurrent endometrial carcinoma to determine the difference in the benefit of chemotherapy in mismatch repair deficient vs mismatch repair proficient endometrial carcinoma. Data on chemotherapy outcomes including objective response rate, progression-free survival (PFS), and overall survival were retrieved. We pooled these data using the inverse variance method and examined subgroup difference by mismatch repair status. We also compared differences in PFS and overall survival outcomes by creating individual patient data from the Kaplan-Meier curves of trial publications for sensitivity analyses.</p><p><strong>Results: </strong>A total of 5 RCTs with 1137 participants (mismatch repair deficient, 26%; mismatch repair proficient, 74%) were included. All participants were treated with carboplatin-based chemotherapy. There was no difference between the mismatch repair deficient and mismatch repair proficient subgroups for objective response rate (66.5% vs 64.0%; P = .20 for subgroup difference), PFS (hazard ratio [HR] = 0.93, 95% confidence interval [CI] = 0.77 to 1.12; P = .44; median PFS = 7.6 vs 9.5 months) or overall survival (HR = 1.03, 95% CI = 0.73 to 1.44; P = .88; median overall survival = not reached vs 28.6 months).</p><p><strong>Conclusions: </strong>Objective response rate, PFS, and overall survival were similar among those with mismatch repair deficient vs mismatch repair proficient endometrial cancer treated with front-line, platinum-doublet chemotherapy in RCTs. These findings reinforce the importance of combining chemotherapy together with immune checkpoint inhibitors until the results of trials comparing immune checkpoint therapy alone with combination therapy are available.</p>","PeriodicalId":14681,"journal":{"name":"JNCI Cancer Spectrum","volume":" ","pages":""},"PeriodicalIF":3.4000,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11552623/pdf/","citationCount":"0","resultStr":"{\"title\":\"Impact of chemotherapy on patients with mismatch repair deficient advanced endometrial carcinomas-a meta-analysis.\",\"authors\":\"Angelina Tjokrowidjaja, Peey-Sei Kok, Yoland C Antill, Clare L Scott, Linda R Mileshkin, Michael L Friedlander, Chee K Lee\",\"doi\":\"10.1093/jncics/pkae101\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Chemo-immunotherapy is standard of care for women with recurrent or advanced mismatch repair deficient endometrial carcinoma. However, it is uncertain whether patients with mismatch repair deficient advanced or recurrent endometrial carcinoma derive less benefit from chemotherapy than those with mismatch repair proficient endometrial carcinoma.</p><p><strong>Methods: </strong>We performed a meta-analysis of randomized controlled trials (RCTs) in advanced or recurrent endometrial carcinoma to determine the difference in the benefit of chemotherapy in mismatch repair deficient vs mismatch repair proficient endometrial carcinoma. Data on chemotherapy outcomes including objective response rate, progression-free survival (PFS), and overall survival were retrieved. We pooled these data using the inverse variance method and examined subgroup difference by mismatch repair status. We also compared differences in PFS and overall survival outcomes by creating individual patient data from the Kaplan-Meier curves of trial publications for sensitivity analyses.</p><p><strong>Results: </strong>A total of 5 RCTs with 1137 participants (mismatch repair deficient, 26%; mismatch repair proficient, 74%) were included. All participants were treated with carboplatin-based chemotherapy. There was no difference between the mismatch repair deficient and mismatch repair proficient subgroups for objective response rate (66.5% vs 64.0%; P = .20 for subgroup difference), PFS (hazard ratio [HR] = 0.93, 95% confidence interval [CI] = 0.77 to 1.12; P = .44; median PFS = 7.6 vs 9.5 months) or overall survival (HR = 1.03, 95% CI = 0.73 to 1.44; P = .88; median overall survival = not reached vs 28.6 months).</p><p><strong>Conclusions: </strong>Objective response rate, PFS, and overall survival were similar among those with mismatch repair deficient vs mismatch repair proficient endometrial cancer treated with front-line, platinum-doublet chemotherapy in RCTs. These findings reinforce the importance of combining chemotherapy together with immune checkpoint inhibitors until the results of trials comparing immune checkpoint therapy alone with combination therapy are available.</p>\",\"PeriodicalId\":14681,\"journal\":{\"name\":\"JNCI Cancer Spectrum\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.4000,\"publicationDate\":\"2024-11-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11552623/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JNCI Cancer Spectrum\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1093/jncics/pkae101\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JNCI Cancer Spectrum","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1093/jncics/pkae101","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
简介:化疗免疫疗法是治疗复发或晚期错配修复缺陷(dMMR)子宫内膜癌(EC)妇女的标准疗法。然而,目前还不确定dMMR晚期或复发性子宫内膜癌患者从化疗中获得的益处是否少于错配修复熟练型(pMMR)子宫内膜癌患者:我们对晚期/复发性EC的随机对照试验(RCT)进行了荟萃分析,以确定dMMR与pMMR EC化疗获益的差异。我们检索了化疗结果数据,包括客观反应率(ORR)、无进展生存期(PFS)和总生存期(OS)。我们使用逆方差法汇总了这些数据,并根据 MMR 状态研究了亚组差异。我们还通过从试验出版物的 Kaplan-Meier 曲线中创建单个患者数据来比较 PFS 和 OS 结果的差异,以进行敏感性分析:共纳入了 5 项 RCT,1137 名参与者(dMMR,26%;pMMR,74%)。所有参与者均接受了以卡铂为基础的化疗。dMMR亚组和pMMR亚组在ORR(66.5% vs 64.0%,亚组差异P = .20)、PFS(HR 0.93,95% CI 0.77-1.12,P = .44;中位PFS 7.6 vs 9.5个月)或OS(HR 1.03,95% CI 0.73-1.44,P = .88;未达到中位OS vs 28.6个月)方面没有差异:结论:在随机临床试验中,dMMR与pMMR子宫内膜癌患者接受一线铂双药化疗的ORR、PFS和OS相似。这些发现加强了化疗与免疫检查点抑制剂联合治疗的重要性,直到将免疫检查点疗法单独与联合疗法进行比较的试验结果出来为止。
Impact of chemotherapy on patients with mismatch repair deficient advanced endometrial carcinomas-a meta-analysis.
Background: Chemo-immunotherapy is standard of care for women with recurrent or advanced mismatch repair deficient endometrial carcinoma. However, it is uncertain whether patients with mismatch repair deficient advanced or recurrent endometrial carcinoma derive less benefit from chemotherapy than those with mismatch repair proficient endometrial carcinoma.
Methods: We performed a meta-analysis of randomized controlled trials (RCTs) in advanced or recurrent endometrial carcinoma to determine the difference in the benefit of chemotherapy in mismatch repair deficient vs mismatch repair proficient endometrial carcinoma. Data on chemotherapy outcomes including objective response rate, progression-free survival (PFS), and overall survival were retrieved. We pooled these data using the inverse variance method and examined subgroup difference by mismatch repair status. We also compared differences in PFS and overall survival outcomes by creating individual patient data from the Kaplan-Meier curves of trial publications for sensitivity analyses.
Results: A total of 5 RCTs with 1137 participants (mismatch repair deficient, 26%; mismatch repair proficient, 74%) were included. All participants were treated with carboplatin-based chemotherapy. There was no difference between the mismatch repair deficient and mismatch repair proficient subgroups for objective response rate (66.5% vs 64.0%; P = .20 for subgroup difference), PFS (hazard ratio [HR] = 0.93, 95% confidence interval [CI] = 0.77 to 1.12; P = .44; median PFS = 7.6 vs 9.5 months) or overall survival (HR = 1.03, 95% CI = 0.73 to 1.44; P = .88; median overall survival = not reached vs 28.6 months).
Conclusions: Objective response rate, PFS, and overall survival were similar among those with mismatch repair deficient vs mismatch repair proficient endometrial cancer treated with front-line, platinum-doublet chemotherapy in RCTs. These findings reinforce the importance of combining chemotherapy together with immune checkpoint inhibitors until the results of trials comparing immune checkpoint therapy alone with combination therapy are available.