Network meta-analysis reveals induction immunochemotherapy plus CCRT improves survival for unresectable esophageal cancer patients compared to CCRT alone
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Key Takeaway
Induction immunochemotherapy plus CCRT improves overall survival; consolidation immunotherapy benefits remain uncertain due to limited trial data.
This systematic review and network meta-analysis evaluated treatment strategies for patients with unresectable esophageal cancer. The study compared induction immunochemotherapy plus concurrent chemoradiotherapy (ICT-CCRT) and concurrent chemoradiotherapy plus consolidation immunotherapy (CCRT-IO) against concurrent chemoradiotherapy alone. Data from 9,648 participants were synthesized to assess overall survival, progression-free survival, and safety profiles across various regimens.
results indicate that induction immunochemotherapy combined with concurrent chemoradiotherapy offers a significant survival advantage over concurrent chemoradiotherapy alone. The hazard ratio for overall survival was 0.52, suggesting a substantial reduction in the risk of death. However, the addition of consolidation immunotherapy after concurrent chemoradiotherapy did not consistently demonstrate a statistically significant benefit for overall survival in the network meta-analysis, though pairwise analyses suggested potential improvements.
Progression-free survival benefits were observed with both strategies, though the evidence for induction immunochemotherapy was strongest in network meta-analysis results. Safety data were not explicitly reported in the source abstract, limiting conclusions regarding tolerability and adverse event rates. The authors caution that sufficient randomized controlled trials are currently lacking to definitively validate efficacy or determine the optimal timing and sequence of these complex interventions.
View Original Abstract ↓
BackgroundConcurrent chemoradiotherapy (CCRT) remains the standard treatment for unresectable esophageal cancer (EC). However, the clinical benefits of combining immunotherapy with CCRT for unresectable EC remain controversial. Therefore, we conducted a systematic review and meta-analysis to evaluate the potential benefits of different immunotherapy strategies added to CCRT in patients with unresectable EC.MethodsWe employed single-arm, pairwise and network meta-analysis (NMA) methods to analyze the overall survival (OS), progression-free survival (PFS), objective response rate (ORR) and safety of several combined treatment strategies based on CCRT.Results30 single-arm trials and 39 controlled trials involving a total of 9648 participants were included. Compared with CCRT alone, both induction immunochemotherapy plus CCRT (ICT-CCRT) and CCRT plus consolidation immunotherapy (CCRT-IO) significantly improved OS in pairwise meta-analyses (HR 0.52, 95% CI 0.39–0.71, I²= 0.0%; HR 0.77, 95% CI 0.65–0.90, I²= 0.0%, respectively). In the NMA, only ICT-CCRT showed a significant OS benefit (HR 0.75, 95% CI 0.64–0.88), whereas CCRT-IO did not. For PFS, CCRT-IO consistently prolonged PFS compared with CCRT alone in both pairwise meta-analyses (HR 0.74, 95% CI 0.64-0.85, I²=0.0%) and NMA (HR 0.78, 95% CI 0.76–0.99). In contrast, ICT-CCRT demonstrated a significant PFS benefit only in the NMA (HR 0.84, 95% CI 0.71–0.99), but not in the pairwise analysis. Notably, ICT-CCRT ranked first in the NMA for both OS and PFS.ConclusionsIn conclusion, compared with CCRT alone, ICT-CCRT significantly improves OS and shows a potential PFS benefit. CCRT-IO improves OS only in pairwise analyses but consistently improves PFS across analyses. Currently, sufficient randomized controlled trials are lacking to validate the efficacy and determine the optimal timing and sequence.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD420261364669.
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