The benefit and risk of addition of PD-1/PD-L1 inhibitors to chemotherapy for advanced cervical cancer: a phase 3 randomized controlled trials based meta-analysis
Abstract Background Chemotherapy has been confirmed as an effective treatment for advanced cervical cancer. However, whether combining PD-1/PD-L1 inhibitors with chemotherapy (PIC) offers superior efficacy remains a subject of debate. This meta-analysis aims to compare the antitumor effects and safe...
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2025-03-01
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| Online Access: | https://doi.org/10.1186/s12885-025-13843-4 |
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| author | Deping Luo Ying Yu Qi Wang Tao Peng Chan Li Wenxiong Zhang Jing Huang |
| author_facet | Deping Luo Ying Yu Qi Wang Tao Peng Chan Li Wenxiong Zhang Jing Huang |
| author_sort | Deping Luo |
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| description | Abstract Background Chemotherapy has been confirmed as an effective treatment for advanced cervical cancer. However, whether combining PD-1/PD-L1 inhibitors with chemotherapy (PIC) offers superior efficacy remains a subject of debate. This meta-analysis aims to compare the antitumor effects and safety profile of PIC versus chemotherapy. Methods We conducted a comprehensive search across six databases to identify eligible randomized controlled trials (RCTs). The primary outcomes assessed were overall survival (OS) and progression-free survival (PFS), while the secondary endpoints included response rates and adverse events (AEs). Results Four RCTs (BEATcc, CALLA, KEYNOTE-826, and KEYNOTE-A18) analyzing 2,857 patients were included. The PIC regimen notably enhanced OS (hazard ratio [HR]: 0.70 [0.61, 0.80], P < 0.00001), PFS (HR: 0.69 [0.61, 0.77], P < 0.00001), objective response rate (ORR) (risk ratio [RR]: 1.11 [1.02, 1.22], P = 0.02), and disease control rate (DCR) (RR: 1.05 [1.01, 1.08], P = 0.004). Improvements in OS and PFS for the PIC group were evident across nearly all subgroups. Moreover, the survival benefit for the PIC group increased with longer patient survival and elevated PD-L1 expression. The PIC group encountered higher rates of grade 3–5 AEs, and serious AEs. The top 5 grade 3–5 AEs were anemia (19.47%), hypertension (12.65%), decreased white blood cell count (11.76%), decreased neutrophil count (11.38%), and neutropenia (10.99%). Conclusions The PIC regimen appears superior to chemotherapy alone for advanced cervical cancer (metastatic/recurrent or locally advanced), demonstrating improved survival and response rates. However, the associated increase in AEs warrants careful consideration in its clinical application. |
| format | Article |
| id | doaj-art-a458f8565aa04e499c3cf599005ce45d |
| institution | DOAJ |
| issn | 1471-2407 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | BMC |
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| series | BMC Cancer |
| spelling | doaj-art-a458f8565aa04e499c3cf599005ce45d2025-08-20T03:01:38ZengBMCBMC Cancer1471-24072025-03-0125111210.1186/s12885-025-13843-4The benefit and risk of addition of PD-1/PD-L1 inhibitors to chemotherapy for advanced cervical cancer: a phase 3 randomized controlled trials based meta-analysisDeping Luo0Ying Yu1Qi Wang2Tao Peng3Chan Li4Wenxiong Zhang5Jing Huang6Department of Gynecological Oncology, Ganzhou Cancer HospitalDepartment of Gynecological Oncology, Ganzhou Cancer HospitalDepartment of Gynecological Oncology, Ganzhou Cancer HospitalDepartment of Gynecological Oncology, Ganzhou Cancer HospitalDepartment of Gynecological Oncology, Ganzhou Cancer HospitalDepartment of Thoracic Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang UniversityDepartment of Gynecological Oncology, Ganzhou Cancer HospitalAbstract Background Chemotherapy has been confirmed as an effective treatment for advanced cervical cancer. However, whether combining PD-1/PD-L1 inhibitors with chemotherapy (PIC) offers superior efficacy remains a subject of debate. This meta-analysis aims to compare the antitumor effects and safety profile of PIC versus chemotherapy. Methods We conducted a comprehensive search across six databases to identify eligible randomized controlled trials (RCTs). The primary outcomes assessed were overall survival (OS) and progression-free survival (PFS), while the secondary endpoints included response rates and adverse events (AEs). Results Four RCTs (BEATcc, CALLA, KEYNOTE-826, and KEYNOTE-A18) analyzing 2,857 patients were included. The PIC regimen notably enhanced OS (hazard ratio [HR]: 0.70 [0.61, 0.80], P < 0.00001), PFS (HR: 0.69 [0.61, 0.77], P < 0.00001), objective response rate (ORR) (risk ratio [RR]: 1.11 [1.02, 1.22], P = 0.02), and disease control rate (DCR) (RR: 1.05 [1.01, 1.08], P = 0.004). Improvements in OS and PFS for the PIC group were evident across nearly all subgroups. Moreover, the survival benefit for the PIC group increased with longer patient survival and elevated PD-L1 expression. The PIC group encountered higher rates of grade 3–5 AEs, and serious AEs. The top 5 grade 3–5 AEs were anemia (19.47%), hypertension (12.65%), decreased white blood cell count (11.76%), decreased neutrophil count (11.38%), and neutropenia (10.99%). Conclusions The PIC regimen appears superior to chemotherapy alone for advanced cervical cancer (metastatic/recurrent or locally advanced), demonstrating improved survival and response rates. However, the associated increase in AEs warrants careful consideration in its clinical application.https://doi.org/10.1186/s12885-025-13843-4PD-1/PD-L1 inhibitorsChemotherapyCervical cancerMeta-analysis |
| spellingShingle | Deping Luo Ying Yu Qi Wang Tao Peng Chan Li Wenxiong Zhang Jing Huang The benefit and risk of addition of PD-1/PD-L1 inhibitors to chemotherapy for advanced cervical cancer: a phase 3 randomized controlled trials based meta-analysis BMC Cancer PD-1/PD-L1 inhibitors Chemotherapy Cervical cancer Meta-analysis |
| title | The benefit and risk of addition of PD-1/PD-L1 inhibitors to chemotherapy for advanced cervical cancer: a phase 3 randomized controlled trials based meta-analysis |
| title_full | The benefit and risk of addition of PD-1/PD-L1 inhibitors to chemotherapy for advanced cervical cancer: a phase 3 randomized controlled trials based meta-analysis |
| title_fullStr | The benefit and risk of addition of PD-1/PD-L1 inhibitors to chemotherapy for advanced cervical cancer: a phase 3 randomized controlled trials based meta-analysis |
| title_full_unstemmed | The benefit and risk of addition of PD-1/PD-L1 inhibitors to chemotherapy for advanced cervical cancer: a phase 3 randomized controlled trials based meta-analysis |
| title_short | The benefit and risk of addition of PD-1/PD-L1 inhibitors to chemotherapy for advanced cervical cancer: a phase 3 randomized controlled trials based meta-analysis |
| title_sort | benefit and risk of addition of pd 1 pd l1 inhibitors to chemotherapy for advanced cervical cancer a phase 3 randomized controlled trials based meta analysis |
| topic | PD-1/PD-L1 inhibitors Chemotherapy Cervical cancer Meta-analysis |
| url | https://doi.org/10.1186/s12885-025-13843-4 |
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