A network analysis of the safety and efficacy of first-line immunotherapy in treating advanced gastric cancer
Objective:To compare the safety and efficacy of first-line immunotherapy in treating advanced gastric cancer.Methods:All clinical trials focused on first-line immunotherapy in advanced gastric can-cer were included in this study.The overall survival,progression-free survival,objective response rate,and Grade 3-5 adverse events were adopted to evaluate the efficacy and safety of immunothera-py.The advanced gastric patients were classified into subgroups based on the programmed cell death 1 ligand 1(PD-L1)Combined Positive Score(CPS).Results:A total of 3 068 patients from 3 phaseⅢ clinical trials were included in this study.Compared with chemotherapy,Pembrolizumab mono-therapy,Pembrolizumab combined chemotherapy,and Nivolumab combined chemotherapy had the most improvement in overall survival and progression-free survival.Among different PD-L1 CPS pa-tients treated by various first-line immunotherapies,PD-L1 CPS≥5 patients receiving Nivolumab combined chemotherapy had more benefits.In contrast to those who received chemotherapy,for dif-ferent PD-L1 CPS patients receiving Pembrolizumab monotherapy,only CPS≥10 patients had pro-longed overall survival.Considering safety,compared with chemotherapy,Pembrolizumab combined chemotherapy,and Nivolumab combined chemotherapy,respectively,Pembrolizumab monotherapy had the fewest Grade 3-5 adverse events.Conclusion:The efficacy and safety of first-line immuno-therapy differed significantly in advanced gastric cancer patients with various PD-L1 expression levels.Our study could provide help in treating advanced gastric cancer with precision immunotherapy in clinic.
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