免疫检查点抑制剂联合曲妥珠单抗和化疗治疗晚期her2阳性胃癌：一项系统综述和荟萃分析

IF 5.6 2区医学 Q1 HEMATOLOGY

Critical reviews in oncology/hematology Pub Date : 2025-10-02 DOI:10.1016/j.critrevonc.2025.104975

Francisco Cezar Aquino de Moraes , Luis Henrique Rios Moreira Rego , Felipe Alves de Paiva , Gustavo Tadeu Freitas Uchôa Matheus , Rommel Mario Rodríguez Burbano

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引用次数: 0

摘要

背景：伴有HER2过表达的胃和胃食管交界处（GEJ）癌对标准HER2靶向治疗的持久反应有限。在抗her2方案中加入免疫检查点抑制剂（ICIs）已成为一种有希望提高治疗效果的策略。本研究评估了ICIs联合曲妥珠单抗治疗her2阳性胃腺癌或GEJ腺癌患者的疗效和安全性。方法根据PRISMA指南进行系统评价和meta分析。符合条件的研究包括her2阳性胃癌或GEJ癌患者，接受化疗抑制剂加曲妥珠单抗治疗，伴或不伴PD-1/PD-L1。使用R 4.4.2版本中的“meta”和“IPDfromKM”包进行统计分析。结果从1306份记录中纳入5项研究，涉及993例患者。联合治疗显著改善OS (HR, 0.73; 95 % CI, 0.64-0.84; p <； .0001)；PFS (HR 0.69; 95年 % CI, 0.60 - -0.80; p & lt; 。);ORR （OR, 1.95; p <； ）。0001)和DCR （OR, 2.94; p = ）。009)也赞成联合治疗。在联合治疗中，虽然结果不显著，但CPS≥ 1的患者有更好的OS倾向（HR: 0.88; 95 % CI, 0.52-1.49; p = ）。58)和PFS(人力资源:0.82;95年 % CI, 0.48 - -1.42; p = 0.4)。联合治疗组甲状腺功能减退发生率更高（RR, 3.24; p = ）。008)，其余11个ae组间无差异。结论：sicis联合曲妥珠单抗治疗可改善晚期her2阳性胃癌或GEJ的生存和反应，特别是pd - l1阳性和一线患者，毒性可控。

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Immune checkpoint inhibitors with trastuzumab and chemotherapy in advanced HER2-positive gastric cancer: A systematic review and meta-analysis

Background

Gastric and gastroesophageal junction (GEJ) cancers with HER2 overexpression have limited durable responses to standard HER2-targeted therapies. Adding immune checkpoint inhibitors (ICIs) to anti-HER2 regimens has emerged as a promising strategy to enhance treatment efficacy. This study assessed the efficacy and safety of combining ICIs with trastuzumab therapy in patients with HER2-positive gastric or GEJ adenocarcinoma.

Methods

A systematic review and meta-analysis was conducted according to PRISMA guidelines. Eligible studies included patients with HER2-positive gastric or GEJ cancer treated with chemotherapy inhibitors plus trastuzumab therapy, with or without PD-1/PD-L1. Statistical analyses were performed using the “meta” and “IPDfromKM” packages in R version 4.4.2.

Results

From 1306 records, five studies involving 993 patients were included. Combination therapy significantly improved OS (HR, 0.73; 95 % CI, 0.64–0.84; p < .0001); PFS (HR, 0.69; 95 % CI, 0.60–0.80; p < .0001); ORR (OR, 1.95; p < .0001) and DCR (OR, 2.94; p = .009) also favored combination therapy. In the combination therapy, although with insignificant results, patients with CPS≥ 1 showed a tendency to better OS (HR: 0.88; 95 % CI, 0.52–1.49; p = .58) and PFS (HR: 0.82; 95 % CI, 0.48–1.42; p = 0.4). Hypothyroidism was more frequent with combination therapy (RR, 3.24; p = .008), while other 11 AEs showed no difference between groups.

Conclusions

ICIs plus trastuzumab therapy improve survival and response in advanced HER2-positive gastric or GEJ cancer, particularly in PD-L1–positive and first-line settings, with manageable toxicity.

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来源期刊

Critical reviews in oncology/hematology 医学-血液学

CiteScore

11.00

自引率

3.20%

发文量

213

审稿时长

55 days

期刊介绍： Critical Reviews in Oncology/Hematology publishes scholarly, critical reviews in all fields of oncology and hematology written by experts from around the world. Critical Reviews in Oncology/Hematology is the Official Journal of the European School of Oncology (ESO) and the International Society of Liquid Biopsy.