Meta-analysis Of Immune Checkpoint Inhibitors In The Treatment Of Recurrent Or Metastatic Cervical Cancer

Background: Cervical cancer(CC)is one of the most common malignant tumors in women.Early cervical cancer can be treated by surgery,radiotherapy and chemotherapy,but for patients with inoperable recurrent or metastatic cervical cancer,the treatment options are limited and the prognosis is poor.In recent years,with the in-depth research on immune checkpoint inhibitors,more treatment options have been provided for recurrent or metastatic cervical cancer.However,at present,there are only a handful of immune checkpoint inhibitors used in the first-line treatment of recurrent or metastatic cervical cancer,but there have been a variety of immune checkpoint inhibitors in the treatment of recurrent or metastatic cervical cancer clinical studies have achieved good results,improving the survival benefits of these patients.Objective: To systematically evaluate the efficacy and safety of immune checkpoint inhibitors in the treatment of recurrent or metastatic cervical cancer.Method: First,the search strategy was formulated according to subject headings and free words,then the inclusion criteria and exclusion criteria were determined,and the databases such as Pubmed,Cochrane Library,EMBASE,CNKI and Clinical Trials,were searched by computer.The literature reports on single or combined immune checkpoint inhibitors in the treatment of recurrent or metastatic cervical cancer were collected and screened by Endnote software.Cochrance bias risk assessment tool was used for quality evaluation in the randomized controlled experiment,and MINORS scale was used for quality evaluation in the single-arm experiment.In this meta-analysis,Rev Man5.4.1 software was used for statistical analysis,and the forest map was used to analyze the heterogeneity of the combined statistics.Results: A total of 10 clinical studies meeting the inclusion criteria were selected,including 2 randomized controlled studies and 8 single-arm studies,with a total of 1902 subjects included.Results of meta-analysis: A total of 1902 patients were treated with immune checkpoint inhibitors,among which 1290 patients were treated with immune checkpoint inhibitors during the whole course of treatment and 612 patients were not treated with immune checkpoint inhibitors during the whole course of treatment.The objective response rate was 28%(95% confidence interval 18% 46%)for all treatment regimeninvolving immune checkpoint inhibitors.Disease control rate: 39%(95% confidence interval: 37.5%-55.9%);12-month progression-free survival was 21%(95% CI: 16%-28%);6-month progression-free survival was 44%(95% CI: 20%-71%);The 12-month overall survival rate was 48%(95% confidence interval(CI): 40.8%-55.4%),all efficacy indicators improved,and the incidence of grade 3-4 adverse reactions was26%(95% confidence interval(CI): 19.3%-35.8%).Subgroup analysis of PD-L1 expression showed an objective response rate of 30.6%(95% confidence interval: 18%‐47%)in PD-L1 positive patients.The objective response rate in PD-L1 negative patients could be considered as 10%(95% confidence interval: 6.5%‐15.2%).Conclusion: 1.In the treatment of recurrent or metastatic cervical cancer,immune checkpoint inhibitor therapy improves objective response rate and disease control rate,as well as prolongs progression-free survival and overall survival.Moreover,in PD-L1 positive patients,the benefit was significant.2.The safety of immune checkpoint inhibitors in the treatment of recurrent or metastatic cervical cancer is controllable,and the medication should be individualized according to the patient’s own situation.