A systematic review examined fifteen randomized controlled trials and cohort studies involving patients with cancer. These studies looked at immune checkpoint inhibitors, which include PD-1, PD-L1, and CTLA-4 inhibitors. The researchers compared these treatments against monotherapy to see how they affected survival and tumor response. They also tracked immune-related adverse events that can occur during treatment.
The review found that these drugs offer durable activity against tumors. Patients with high tumor mutational burden and specific PD-L1 expression showed favorable outcomes. Additionally, using combination strategies like dual checkpoint blockade or adding chemotherapy demonstrated superior clinical results compared to using a single drug alone.
Safety remains a significant concern. Immune-related adverse events can manifest as skin rashes, hepatitis, diarrhea, colitis, hypopituitarism, and pneumonitis. Some reports indicate substantial adverse events that require immunosuppressive management. The role of certain factors in predicting these side effects remains investigational and is not supported by robust evidence. Readers should understand that toxicity is a key issue to manage carefully.