Efficacy and safety of PD-1 inhibitor plus chemotherapy in advanced nasopharyngeal carcinoma: A meta-analysis

Background: The combination of programmed cell death protein 1 (PD-1) inhibitors and chemotherapy has shown promising results in the treatment of various malignancies. This meta-analysis aims to evaluate the effectiveness and safety of combing PD-1 inhibitor with chemotherapy in patients with advanced NPC. Methods: A thorough search of the literature was carried out using comprehensive methods. The assessed outcomes included overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and adverse events (AEs). Results: This meta-analysis included seven studies with a total of 1204 patients. The use of a combination therapy involving PD-1 inhibitor and chemotherapy demonstrated significant improvements in OS (HR=0.60, 95%CI: 0.45, 0.80; P<0.001), PFS (HR=0.51, 95%CI: 0.42, 0.61; P<0.001), ORR (RR=1.23, 95%CI: 1.07, 1.40; P=0.003) and DCR (RR=1.13, 95%CI: 1.03, 1.23; P=0.003) compared to other treatments in patients with advanced NPC. Subgroup analyses based on PD-1 inhibitor type, chemotherapy regimen and study design indicated that these factors influenced OS but not PFS. Prognostic factor analysis consistently demonstrated a PFS benefit associated with the combination treatment across various patient subgroups. The incidences of AEs, grade 3 or higher AEs were comparable between the two groups. However, the combination group was significantly more likely to discontinue treatment because of AEs. Conclusion: This meta-analysis provides evidence supporting the effectiveness and safety of PD-1 inhibitor plus chemotherapy in advanced NPC. The combination therapy showed superior outcomes in terms of OS, PFS, ORR, and DCR.