Meta Analysis Of The Safety And Efficacy Of PD-1/PD-L1 Immunosuppressant In The Treatment Of Recurrent Refractory Ovarian Cancer

Objective:To explore the role of PD-1/PD-L1 immunosuppressant in the treatment of recurrent refractory ovarian cancer.Methods:The first step is to determine the inclusion criteria,and then to formulate a search strategy based on keywords,search English literature on Cochrane library,Pubmed and EMBASE,search Chinese literature on Zhiwang,Wanfang and VIP,search registered clinical trials on Clinical Trials.gov,collect all literature reports about PD-1/PD-L1 immunosuppressant monotherapy in the treatment of recurrent or refractory ovarian cancer since the establishment of the database,and use Endnote to screen the literature.The MINORS scale was used to evaluate the risk of the included trials.In this meta-analysis,the included study was statistically analyzed by Revman5.3 software,and the forest map was used to analyze the heterogeneity of combined statistics.When the heterogeneity test result was P > 0.05 and I ~2< 50%,it was considered that multiple independent studies were homogeneous and fixed effect model was used: on the contrary,multiple studies were heterogeneity and random effect model was selected.The published offset of each outcome index was analyzed according to the funnel chart.The adverse reactions were all in accordance with the American NC3.0 version of adverse events(adverse events,E)criteria.Results:A total of 11 articles in accordance with the inclusion criteria were selected,and the included studies were statistically analyzed by Revman5.3,and relevant conclusions were drawn.The clinical studies including 8 single-arm studies,1 cohort study and 2 case-control studies with a total of 735 patients.A single PD-1/PD-L1 inhibitor was used in the selected study group.The PD-1/PD-L1 inhibitors used included perbutrazumab(n = 3),Navumab(n = 3),Averuximab(n = 2),atrazumab(n= 1),tisilimumab(n = 1)and BMS-93655(n = 1).META analysis showed that the objective remission rate using PD-1/PD-L1 immunosuppressants was 10%(95%confidence interval: 7.4% Mel 12.3%).The disease control rate was 39%(95%confidence interval: 32.4% mi 46.5%).The 1-year progress-free survival of the merger is 13%(95% confidence interval: 9.1% muri 19.4%).The 6-month progress-free survival time of the merger is 22%(95% confidence interval: 14.5%Murray 32.0%).The overall 1-year survival rate of the combined group was 48%(95% confidence interval: 40.8% mi 55.4%).The incidence of combined grade 3-4adverse reactions was 18%(95% confidence interval: 11.5% mae 27.0%).The objective remission rate of(ORR)was divided into two subgroups according to PD-L1 negative and positive: the combined ORR of PD-L1 positive and negative patients was 12.3%(95% confidence interval: 9.1% mi 16.0%)and 7%(95%confidence interval: 4.8% 12.3%).The incidence of adverse reactions of DCR and grade 3-4 were heterogeneous in META analysis,which was mainly due to the differences in medication regimen and supportive nursing care of patients.The results of clinical studies show that PD-1/PD-L1 immunocheckpoint inhibitor as a monotherapy is a promising method for the treatment of gynecological cancer.Future research may lead to the development of effective treatment for patients with gynecological cancer.Conclusion:1.In the treatment of recurrent or refractory ovarian cancer,PD-1 / PD-L1 immunosuppressive therapy can improve the objective remission rate and disease control rate of patients,but there is no obvious evidence for the improvement of overall survival,which needs to be confirmed by more research and data.2.In the treatment of recurrent or refractory ovarian cancer,the incidence of grade 3-4 adverse reactions is higher,which should be used according to the individual condition of the patients.3.Conducting multiple randomized controlled trials and providing high-quality evidence of evidence-based medicine is the fundamental way to further clarify the treatment of PD-1 / PD-L1 immunosuppressants and solve clinical related problems.