PMID- 35031491 OWN - NLM STAT- MEDLINE DCOM- 20220506 LR - 20220506 IS - 1521-7035 (Electronic) IS - 1521-6616 (Linking) VI - 236 DP - 2022 Mar TI - Optimal first-line treatment for platinum-eligible metastatic urothelial carcinoma: Comparison of chemo-immunotherapy, immunotherapy, and chemotherapy- A systematic review and meta-analysis. PG - 108927 LID - S1521-6616(22)00007-9 [pii] LID - 10.1016/j.clim.2022.108927 [doi] AB - BACKGROUND: The role of first-line of immunotherapy in metastatic urothelial carcinoma (mUC) remains unclear. This meta-analysis aimed to explore an optimal first-line treatment strategy for mUC patients. METHODS: We carried out a meta-analysis between chemo-immunotherapy, immunotherapy, and chemotherapy in mUC based on randomized trials. The outcomes included overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and treatment-related adverse events (AEs). A fixed-effect or random-effects model was adopted depending on between-study heterogeneity. RESULTS: Three trials involving 3238 patients were included. PD-1/PD-L1 inhibitor plus platinum-based chemotherapy was associated with the improvements of OS (HR, 0.85; 95% CI 0.75-0.99), PFS (HR, 0.80; 95% CI 0.71-0.90) and ORR (OR, 1.32; 95% CI 1.07-1.63) when compared with platinum-based chemotherapy, but not with better DCR (OR, 1.07; 95% CI 0.78-1.46). PD-1/PD-L1 inhibitor alone was associated with worse ORR (OR, 0.38; 95% CI 0.17-0.87) and DCR (OR, 0.20; 95% CI 0.16-0.25) when compared with platinum-based chemotherapy while it did not statistically reduce the risk of mortality (HR 0.97 for entire cohort; 0.90 for PD-L1 high cohort). In safety analyses, the incidence of adverse events (AEs) between regimens showed no difference, but the frequency of AEs of grade 3 or severity was higher in chemo-immunotherapy compared to chemotherapy. CONCLUSIONS: Compared with platinum-based chemotherapy, chemo-immunotherapy is associated with significantly improved PFS, OS, and ORR in the first-line therapy for mUC at the expanse of increased toxicity. CI - Copyright (c) 2022. Published by Elsevier Inc. FAU - Li, Haifeng AU - Li H AD - State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou 510060, PR China; Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China. FAU - Ni, Mengqian AU - Ni M AD - State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou 510060, PR China; Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China. FAU - Xue, Cong AU - Xue C AD - State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou 510060, PR China; Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China. FAU - Li, Lu AU - Li L AD - State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou 510060, PR China; Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China. FAU - Huang, Riqing AU - Huang R AD - State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou 510060, PR China; Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China. FAU - Yang, Wei AU - Yang W AD - State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou 510060, PR China; Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China. FAU - Hu, Anqi AU - Hu A AD - State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou 510060, PR China; Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China. FAU - An, Xin AU - An X AD - State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou 510060, PR China; Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China. Electronic address: anxin@sysucc.org.cn. FAU - Shi, Yanxia AU - Shi Y AD - State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou 510060, PR China; Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China. Electronic address: shiyx@sysucc.org.cn. LA - eng PT - Journal Article PT - Meta-Analysis PT - Research Support, Non-U.S. Gov't PT - Systematic Review DEP - 20220111 PL - United States TA - Clin Immunol JT - Clinical immunology (Orlando, Fla.) JID - 100883537 RN - 0 (Immune Checkpoint Inhibitors) RN - 0 (Programmed Cell Death 1 Receptor) RN - 49DFR088MY (Platinum) SB - IM MH - *Carcinoma, Transitional Cell/drug therapy MH - Female MH - Humans MH - Immune Checkpoint Inhibitors/therapeutic use MH - Immunotherapy MH - *Lung Neoplasms/pathology MH - Male MH - Platinum/therapeutic use MH - Programmed Cell Death 1 Receptor MH - *Urinary Bladder Neoplasms/drug therapy EDAT- 2022/01/16 06:00 MHDA- 2022/05/07 06:00 CRDT- 2022/01/15 05:41 PHST- 2021/07/11 00:00 [received] PHST- 2022/01/09 00:00 [accepted] PHST- 2022/01/16 06:00 [pubmed] PHST- 2022/05/07 06:00 [medline] PHST- 2022/01/15 05:41 [entrez] AID - S1521-6616(22)00007-9 [pii] AID - 10.1016/j.clim.2022.108927 [doi] PST - ppublish SO - Clin Immunol. 2022 Mar;236:108927. doi: 10.1016/j.clim.2022.108927. Epub 2022 Jan 11.