Efficacy of Immune Checkpoint Inhibitors against Advanced or Metastatic Neuroendocrine Neoplasms: A Systematic Review and Meta-Analysis

• Published in: Cancers Vol. 14; no. 3; p. 794
• Main Authors: Park, Eun-Joo, Park, Hyo-Jung, Kim, Kyung-Won, Suh, Chong-Hyun, Yoo, Changhoon, Chae, Young-Kwang, Tirumani, Sree Harsha, Ramaiya, Nikhil H
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 04.02.2022; MDPI
• Subjects: Bias; Cancer therapies; Clinical outcomes; Clinical trials; Immune checkpoint; Immune checkpoint inhibitors; Medical prognosis; Meta-analysis; Metastases; Metastasis; Neuroendocrine tumors; Patients; Regression analysis; Sensitivity analysis; Survival; Systematic Review; Thorax; Tumors; checkpoint inhibitors; immunotherapy; neuroendocrine neoplasm; treatment efficacy
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers14030794

We performed a systematic review and meta-analysis of the treatment efficacy of immune checkpoint inhibitors (ICIs) in advanced/metastatic neuroendocrine neoplasms (NENs). MEDLINE and EMBASE were searched to identify studies that provide data on treatment response and/or survival outcomes of advanced/metastatic NEN patients treated with ICIs. The overall response rate (ORR) was pooled using a random-effects model. Meta-regression was performed to explore factors influencing the ORR. Individual patient data (IPD) meta-analysis of survival was performed using stratified Cox regression. Ten studies (464 patients) were included. The overall pooled ORR was 15.5% (95% confidence interval (CI), 9.5-24.3%), and it varied according to the primary site (thoracic, 24.7%; gastro-entero-pancreatic, 9.5%), tumor differentiation (poorly differentiated, 22.7%; well-differentiated, 10.4%), and drug regimen (combination, 25.3%; monotherapy, 10.1%). All these variables significantly influenced the ORR. Tumor differentiation was associated with both overall survival and progression-free survival (hazard ratio of poorly differentiated tumors, 4.2 (95% CI, 2.0-8.7) and 2.6 (95% CI, 1.6-4.4), respectively). Thus, the treatment efficacy of ICIs for advanced/metastatic NENs varied according to primary site, tumor differentiation, and drug regimen. Poorly differentiated NENs showed a better ORR than well-differentiated NENs but had a negative impact on survival.