European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2025
Comparative short-term outcomes of peri-operative immunotherapy and targeted therapy for gastric and gastroesophageal junction adenocarcinoma: a systematic review and network meta-analysis.
СтатьяСистематический обзорМетаанализСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Zhang Fei, Yan Ying, Li Baifeng, Wang Yi, Ge Chunlin
Аннотация
INTRODUCTION: Although perioperative chemotherapy (CT) is considered the standard treatment for gastric and gastroesophageal junction (GEJ) adenocarcinoma, the incorporation of novel agents into these standard regimens could potentially improve patient prognosis. The combination of immunotherapy and targeted therapies with chemotherapy may improve efficacy; however, there is no head-to-head comparison of the advantages and disadvantages of different combination schemes. Therefore, we performed a network meta-analysis (NMA) to compare the short-term outcomes of these novel neoadjuvant treatments for gastric and GEJ adenocarcinoma.
METHODS: Eligible studies were searched in Embase, PubMed, Scopus, and Web of Science from inception until January 13, 2025, for randomized clinical trials (RCTs) that enrolled adults with gastric and GEJ adenocarcinoma and provided data regarding outcomes measures, comprised pathologic complete response (pCR), R0 resection rate, grade 3-4 treatment-related adverse events (AEs), overall survival (OS), and disease-free survival (DFS). Surface under the cumulative rank (SUCRA) curve plots were produced.
RESULTS: A total of 10 RCTs containing 3173 patients were involved. The NMA results demonstrated that Toripalimab combined with chemotherapy showed a favorable trend for pCR (OR 3.43, 95 % CrI 0.20-51.35) and was a safer treatment (OR 0.84, 95 % CrI 0.15-4.46). However, there were no differences between pairwise comparisons. Furthermore, there was an improvement in R0 resection rates (OR 5.23, 95 % CrI 0.55-70.68) for Camrelizumab and Rivoceranib combined with chemotherapy when compared with chemotherapy alone. Nevertheless, it is worth noting that Camrelizumab and Rivoceranib combined with chemotherapy increased the risk of grade 3-4 treatment-related AEs (OR 2.51, 95 % CrI 0.56-9.87).
CONCLUSION: The absence of direct head-to-head trials prompted the use of a network meta-analysis to compare the short-term efficacy of treatment regimens for gastric and gastroesophageal junction adenocarcinoma. Our findings suggest that immunotherapies or targeted therapies, when combined with chemotherapy, are likely to yield superior pathological responses compared to chemotherapy alone. However, these conclusions are based on intermediate endpoints and on limited study quality. Therefore, definitive ranking of these regimens requires validation through large, well-designed, direct randomized trials focused on long-term survival outcomes.
METHODS: Eligible studies were searched in Embase, PubMed, Scopus, and Web of Science from inception until January 13, 2025, for randomized clinical trials (RCTs) that enrolled adults with gastric and GEJ adenocarcinoma and provided data regarding outcomes measures, comprised pathologic complete response (pCR), R0 resection rate, grade 3-4 treatment-related adverse events (AEs), overall survival (OS), and disease-free survival (DFS). Surface under the cumulative rank (SUCRA) curve plots were produced.
RESULTS: A total of 10 RCTs containing 3173 patients were involved. The NMA results demonstrated that Toripalimab combined with chemotherapy showed a favorable trend for pCR (OR 3.43, 95 % CrI 0.20-51.35) and was a safer treatment (OR 0.84, 95 % CrI 0.15-4.46). However, there were no differences between pairwise comparisons. Furthermore, there was an improvement in R0 resection rates (OR 5.23, 95 % CrI 0.55-70.68) for Camrelizumab and Rivoceranib combined with chemotherapy when compared with chemotherapy alone. Nevertheless, it is worth noting that Camrelizumab and Rivoceranib combined with chemotherapy increased the risk of grade 3-4 treatment-related AEs (OR 2.51, 95 % CrI 0.56-9.87).
CONCLUSION: The absence of direct head-to-head trials prompted the use of a network meta-analysis to compare the short-term efficacy of treatment regimens for gastric and gastroesophageal junction adenocarcinoma. Our findings suggest that immunotherapies or targeted therapies, when combined with chemotherapy, are likely to yield superior pathological responses compared to chemotherapy alone. However, these conclusions are based on intermediate endpoints and on limited study quality. Therefore, definitive ranking of these regimens requires validation through large, well-designed, direct randomized trials focused on long-term survival outcomes.