Efficacy and safety of PD-1/PD-L1 inhibitor monotherapy or combination therapy versus platinum-based chemotherapy as a first-line treatment of advanced urothelial cancer: A systematic review and meta-analysis

• Published in: Current urology Vol. 19; no. 3; pp. 157 - 167
• Main Authors: He, Xiaohui, Huang, Shibo, Jiang, Qiuhong, Huang, Conghui, Huang, Weisheng, Liang, Weiming
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01.05.2025; Wolters Kluwer Health
• Subjects: Reviews; Programmed death-ligand 1 inhibitor; Programmed cell death protein 1; Urothelial carcinoma; Immune-checkpoint inhibitor
• ISSN: 1661-7649; 1661-7657
• DOI: 10.1097/CU9.0000000000000275

Abstract Background Recent clinical trials have shown that inhibitors targeting programmed cell death protein 1 (PD-1) or its ligand (programmed cell death-ligand 1 [PD-L1]) provide significant efficacy and clinical benefit in the treatment of advanced or metastatic urothelial carcinoma (UC). This systematic review and meta-analysis aimed to compare the effectiveness and safety of PD-1/PD-L1 inhibitors in combination with chemotherapy or PD-1/PD-L1 inhibitor monotherapy versus platinum-based chemotherapy as a first-line treatment for advanced UC. Materials and methods From the beginning of the database construction to February 4, 2024, a combination of medical subject headings and free-text words was searched using the Population Intervention Comparison Outcome Study design framework. The PubMed, Cochrane Library, Embase, and Web of Science electronic databases were searched. Meta-analyses of progression-free survival, overall survival, objective response rate (ORR), complete remission rate, duration of remission, and grade ≥3 adverse events were performed. Results Four studies were included in the meta-analysis. The PD-1/PD-L1 inhibitors plus chemotherapy therapy is associated with significantly better ORR compared with chemotherapy. Unfortunately, there were no significant differences between PD-1/PD-L1 inhibitor monotherapy and chemotherapy in terms of ORR, duration of remission, or overall survival. Conclusions Our findings indicate that PD-1/PD-L1 inhibitors plus chemotherapy therapy provides more oncological advantages than standard chemotherapy and should be recommended as a first-line treatment for advanced or metastatic UC. Attention must also be paid to the adverse effects of the combination of PD-1/PD-L1 inhibitors and chemotherapy.