The efficacy and safety of immune checkpoint inhibitors combined with antiangiogenic drugs in renal cell carcinomas: a systematic review and meta-analysis

Qian He; Jiayi Li; Chi Zhang; Sheng Tang; Qinglan Ren

doi:10.21037/tcr-20-1975

The efficacy and safety of immune checkpoint inhibitors combined with antiangiogenic drugs in renal cell carcinomas: a systematic review and meta-analysis

Transl Cancer Res. 2020 Nov;9(11):6780-6791. doi: 10.21037/tcr-20-1975.

Authors

Qian He¹, Jiayi Li¹, Chi Zhang¹, Sheng Tang¹, Qinglan Ren¹

Affiliation

¹ Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Abstract

Background: The treatment of solid malignant tumors using immune checkpoint inhibitors (ICIs) combined with antiangiogenic drugs, has gradually become an active field of clinical research. However, the results are inconsistent. Therefore, we designed this meta-analysis to evaluate the efficacy and safety of ICIs combined with antiangiogenic drugs in patients with solid malignant tumors. We found that the focus of combination therapy studies was on renal cell carcinomas (RCC).

Methods: We searched PubMed, Embase, and the Cochrane Library to summarize the hazard ratio (HR) for overall survival (OS), progression-free survival (PFS), and the odds ratio (OR) for objective response rate (ORR), disease control rate (DCR), and adverse events (AEs) of grade 3 or higher.

Results: A total of 6 studies were included. We found that patients who received antiangiogenic drugs combined with ICIs had better OS [HR =0.74, 95% confidence interval (CI): 0.60-0.89], PFS (HR =0.79, 95% CI: 0.70-0.89), ORR (OR =2.34, 95% CI: 1.35-4.04) and DCR (OR =1.52, 95% CI: 1.21-1.91) than those without ICIs. There was no significant difference in the incidence of grade 3 or higher AEs (OR =0.76, 95% CI: 0.52-1.11). Subgroup analyses showed that combination therapy resulted in a lower risk of death in patients with PD-L1 expression ≥1% or <1%, and better PFS in patients with RCCs who were of different ages, different genders, and different International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk scores (favorable/intermediate/poor).

Conclusions: The results of this meta-analysis suggest that ICIs combined with antiangiogenic drugs can provide more clinical benefits to patients with solid malignant tumors without significantly increasing side effects. More clinical trials are needed to validate these findings further.

Keywords: Immune checkpoint inhibitor (ICI); angiogenesis inhibitor; immunotherapy; renal cell carcinomas (RCCs); vascular endothelial growth factor (VEGF).