The efficacy of immune checkpoint inhibitors on low PD‐L1 cervical cancer: A meta‐analysis

Abstract

Abstract Background and Aims The effectiveness of immune checkpoint inhibitors (ICIs) in low programmed death ligand 1 (PD‐L1) expression in cervical cancer (CC) patients remains unknown. We aimed to evaluate the efficacy of ICIs in low PD‐L1 expression CC patients. Methods The study is an individual patient data (IPD)‐based meta‐analysis. IPD were compiled through KMSubtraction and IPDfromKM methodologies from high‐quality randomized clinical trials and single‐arm studies which reported overall survival (OS) or progression‐free survival (PFS) stratified by PD‐L1 expression. Kaplan−Meier curves and Cox regression analysis were employed to evaluate the survival benefits of ICIs. Results A total of eight studies and 1110 cases were included in the analysis. Within the low PD‐L1 expression subgroup, ICI combination therapy, but not ICI monotherapy, demonstrated significant OS benefits over non‐ICI treatment (hazard ratio [HR] = 0.61, 95% confidence interval [CI]: 0.36−1.04, p = 0.06). Concerning PFS, ICI monotherapy was associated with a negative effect compared to non‐ICI treatment (HR = 4.59, 95% CI: 2.32−9.07, p < 0.001). Notably, both OS and PFS outcomes were unfavorable for ICI monotherapy compared to both non‐ICI and ICI combination therapy in the combined positive score <1 subgroup (OS: HR = 2.60, 95% CI: 1.31−5.16, p = 0.008; PFS: HR = 7.59, 95% CI: 3.53−16.31, p < 0.001). Conclusion In patients with CC and low PD‐L1 expression, ICI monotherapy may not be considered as the optimal treatment strategy when compared to non‐ICI treatment or ICI combination therapy. Registration CRD42023395103.

Keywords

• cervical cancer
• chemotherapy
• immune checkpoint inhibitor
• immunotherapy
• meta‐analysis
• prognosis