Efficacy of Chemoimmunotherapy versus Chemotherapy for Gastric Cancer: A Meta-Analysis of Survival Outcomes


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Abstract

Background:Gastric cancer has been traditionally treated with chemotherapy as the primary mode of treatment. However, recent studies have shown that chemoimmunotherapy is also effective and, in some cases, better than chemotherapy treatment. Current study aimed to find the efficacy of chemoimmunotherapy versus chemotherapy in the treatment of gastric cancer.

Methods:Using electronic databases, including PubMed, Embase, and EBSCO, a thorough literature search was carried out for the years 2006 to 2023. The search strategy was designed to identify relevant studies based on chemoimmunotherapy and chemotherapy intervention, and the search was conducted using appropriate keywords and MeSH terms. The retrieved studies were screened for relevance based on their titles, abstracts, and full texts. The studies' inclusion criteria were predefined, and the selected studies were then subjected to a quality assessment using GradePro GDT. The data from selected studies were extracted and analyzed using Revman version 5.4.

Results:The study found that chemoimmunotherapy treatment resulted in a significant improvement in overall survival (OS) with a risk ratio (RR) of 1.54 and a 95% Confidence Interval (CI) of 1.25 to 1.89. The overall effect was also found to be significant, with a p-value of less than 0.001. Furthermore, we also observed an improvement in the 1-year, 3-year, and 5-year survival rates with risk ratio (RR) of 1.09 (95% CI: 1.01, 1.17), 1.43 (95% CI: 1.28, 1.60), and 1.59 (95% CI: 1.10, 2.30), respectively. In addition, it’s also found that chemoimmunotherapy treatment also resulted in an improvement in DFS with an RR of 1.94 and a 95% CI of 1.44 to 2.59. Overall, these results suggest that chemoimmunotherapy treatment can be an effective approach in comparison to chemotherapy for improving overall survival and disease-free survival in the studied population.

Conclusion:This study comparing chemoimmunotherapy versus chemotherapy for gastric cancer showed that both treatments were effective, but chemoimmunotherapy had more significant efficacy. To support these results, additional studies with a large sample size and a longer follow-up time are required.

About the authors

Juan Xie

School of Pharmaceutical Science, Hengyang Medical School,, University of South China

Email: info@benthamscience.net

Lin Chen

School of Pharmaceutical Science, Hengyang Medical School, University of South China

Email: info@benthamscience.net

Qing Liu

School of Pharmaceutical Science, Hengyang Medical School, University of South China

Email: info@benthamscience.net

Xi-Tai Li

School of Pharmaceutical Science, Hengyang Medical School, University of South China

Email: info@benthamscience.net

Xiao-Yong Lei

School of Pharmaceutical Science, Hengyang Medical School, University of South China

Author for correspondence.
Email: info@benthamscience.net

References

  1. Wong, M.C.S.; Huang, J.; Chan, P.S.F.; Choi, P.; Lao, X.Q.; Chan, S.M.; Teoh, A.; Liang, P. Global incidence and mortality of gastric cancer, 1980-2018. JAMA Netw. Open, 2021, 4(7), e2118457. doi: 10.1001/jamanetworkopen.2021.18457 PMID: 34309666
  2. Sung, H.; Ferlay, J.; Siegel, R.L.; Laversanne, M.; Soerjomataram, I.; Jemal, A.; Bray, F. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J. Clin., 2021, 71(3), 209-249. doi: 10.3322/caac.21660 PMID: 33538338
  3. Dolcetti, R.; De Re, V.; Canzonieri, V. Immunotherapy for gastric cancer: Time for a personalized approach? Int. J. Mol. Sci., 2018, 19(6), 1602. doi: 10.3390/ijms19061602 PMID: 29844297
  4. Takei, S.; Kawazoe, A.; Shitara, K. The new era of immunotherapy in gastric cancer. Cancers, 2022, 14(4), 1054. doi: 10.3390/cancers14041054 PMID: 35205802
  5. Mu, W.; Chu, Q.; Liu, Y.; Zhang, N. A review on nano-based drug delivery system for cancer chemoimmunotherapy. Nano-Micro Lett., 2020, 12(1), 142. doi: 10.1007/s40820-020-00482-6 PMID: 34138136
  6. Salas-Benito, D.; Pérez-Gracia, J.L.; Ponz-Sarvisé, M.; Rodriguez-Ruiz, M.E.; Martínez-Forero, I.; Castañón, E.; López-Picazo, J.M.; Sanmamed, M.F.; Melero, I. Paradigms on immunotherapy combinations with chemotherapy. Cancer Discov., 2021, 11(6), 1353-1367. doi: 10.1158/2159-8290.CD-20-1312 PMID: 33712487
  7. Jiang, H.; Wang, J.; Deng, W. Pathologic complete response to chemoimmunotherapy of an advanced gastric cancer patient with high PD-L1 expression, dMMR, and unique gut microbiota composition: A case report. Front. Oncol., 2023, 13, 1150931. doi: 10.3389/fonc.2023.1150931 PMID: 37007083
  8. Garofano, F.; Gonzalez-Carmona, M.A.; Skowasch, D.; Schmidt-Wolf, R.; Abramian, A.; Hauser, S.; Strassburg, C.P.; Schmidt-Wolf, I.G.H. Clinical trials with combination of cytokine-induced killer cells and dendritic cells for cancer therapy. Int. J. Mol. Sci., 2019, 20(17), 4307. doi: 10.3390/ijms20174307 PMID: 31484350
  9. Wang, S.; Wang, X.; Zhou, X.; Lyerly, H.K.; Morse, M.A.; Ren, J. DC-CIK as a widely applicable cancer immunotherapy. Expert Opin. Biol. Ther., 2020, 20(6), 601-607. doi: 10.1080/14712598.2020.1728250 PMID: 32033522
  10. Murugan, D.; Murugesan, V.; Panchapakesan, B.; Rangasamy, L. Nanoparticle enhancement of Natural Killer (NK) cell-based immunotherapy. Cancers, 2022, 14(21), 5438. doi: 10.3390/cancers14215438 PMID: 36358857
  11. Sharma, A.; Schmidt-Wolf, I.G.H. 30 years of CIK cell therapy: recapitulating the key breakthroughs and future perspective. J. Exp. Clin. Cancer Res., 2021, 40(1), 388. doi: 10.1186/s13046-021-02184-2 PMID: 34886895
  12. Zhang, X.; Yang, J.; Zhang, G.; Lu, P.A. 11-Year clinical summary of DC - CIK / NK cell immunotherapy for 152 patients with acute myeloid leukemia. Blood, 2017, 130(Suppl. 1), 1369-69. doi: 10.1182/blood.V130.Suppl_1.1369.1369
  13. Joshi, S.S.; Badgwell, B.D. Current treatment and recent progress in gastric cancer. CA Cancer J. Clin., 2021, 71(3), 264-279. doi: 10.3322/caac.21657 PMID: 33592120
  14. Esfahani, K.; Roudaia, L.; Buhlaiga, N.; Del Rincon, S.V.; Papneja, N.; Miller, W.H., Jr A review of cancer immunotherapy: from the past, to the present, to the future. Curr. Oncol., 2020, 27(12)(Suppl. 2), 87-97. doi: 10.3747/co.27.5223 PMID: 32368178
  15. Xie, T.; Zhang, Z.; Zhang, X.; Qi, C.; Shen, L.; Peng, Z. Appropriate PD-L1 cutoff value for gastric cancer immunotherapy: A systematic review and meta-analysis. Front. Oncol., 2021, 11, 646355. doi: 10.3389/fonc.2021.646355 PMID: 34540656
  16. Liberati, A.; Altman, D.G.; Tetzlaff, J.; Mulrow, C.; Gøtzsche, P.C.; Ioannidis, J.P.A.; Clarke, M.; Devereaux, P.J.; Kleijnen, J.; Moher, D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. PLoS Med., 2009, 6(7), e1000100. doi: 10.1371/journal.pmed.1000100 PMID: 19621070
  17. Schünemann, H.J.; Best, D.; Vist, G.; Oxman, A.D.; Group, G.W. Letters, numbers, symbols and words: How to communicate grades of evidence and recommendations. CMAJ, 2003, 169(7), 677-680. PMID: 14517128
  18. GRADEpro GDT. GRADEpro GDT: GRADEpro guideline development tool. McMaster University and Evidence Prime 2022. Available from: gradepro.org
  19. Liu, G.; Chen, D.; Zhao, X.; You, X.; Huang, C.; Cheng, Z.; Mao, X.; Zhou, H. Efficacy of DC-CIK immunotherapy combined with chemotherapy on locally advanced gastric cancer. J. Oncol., 2022, 2022, 1-6. doi: 10.1155/2022/5473292 PMID: 35865086
  20. Knödler, M.; Körfer, J.; Kunzmann, V.; Trojan, J.; Daum, S.; Schenk, M.; Kullmann, F.; Schroll, S.; Behringer, D.; Stahl, M.; Al-Batran, S.E.; Hacker, U.; Ibach, S.; Lindhofer, H.; Lordick, F. Randomised phase II trial to investigate catumaxomab (anti-EpCAM × anti-CD3) for treatment of peritoneal carcinomatosis in patients with gastric cancer. Br. J. Cancer, 2018, 119(3), 296-302. doi: 10.1038/s41416-018-0150-6 PMID: 29988111
  21. Sahin, U.; Türeci, Ö.; Manikhas, G.; Lordick, F.; Rusyn, A.; Vynnychenko, I.; Dudov, A.; Bazin, I.; Bondarenko, I.; Melichar, B.; Dhaene, K.; Wiechen, K.; Huber, C.; Maurus, D.; Arozullah, A.; Park, J.W.; Schuler, M.; Al-Batran, S.E. FAST: a randomised phase II study of zolbetuximab (IMAB362) plus EOX versus EOX alone for first-line treatment of advanced CLDN18.2-positive gastric and gastro-oesophageal adenocarcinoma. Ann. Oncol., 2021, 32(5), 609-619. doi: 10.1016/j.annonc.2021.02.005 PMID: 33610734
  22. Malka, D.; François, E.; Penault-Llorca, F.; Castan, F.; Bouché, O.; Bennouna, J.; Ghiringhelli, F.; de la Fouchardière, C.; Borg, C.; Samalin, E.; Bachet, J.B.; Raoul, J.L.; Miglianico, L.; Bengrine-Lefèvre, L.; Dahan, L.; Lecaille, C.; Aparicio, T.; Stanbury, T.; Perrier, H.; Cayre, A.; Laurent-Puig, P.; Gourgou, S.; Emile, J.F.; Taïeb, J. FOLFOX alone or combined with rilotumumab or panitumumab as first-line treatment for patients with advanced gastroesophageal adenocarcinoma (PRODIGE 17-ACCORD 20-MEGA): A randomised, open-label, three-arm phase II trial. Eur. J. Cancer, 2019, 115, 97-106. doi: 10.1016/j.ejca.2019.04.020 PMID: 31129386
  23. Liu, T.; Bai, Y.; Lin, X.; Li, W.; Wang, J.; Zhang, X.; Pan, H.; Bai, C.; Bai, L.; Cheng, Y.; Zhang, J.; Zhong, H.; Ba, Y.; Hu, W.; Xu, R.; Guo, W.; Qin, S.; Yang, N.; Lu, J.; Shitara, K.; Lei, M.; Li, M.; Bao, N.; Chen, T.; Shen, L. First- line nivolumab plus chemotherapy vs. chemotherapy in patients with advanced gastric, gastroesophageal junction and esophageal adenocarcinoma: CHECKMATE 649 Chinese subgroup analysis. Int. J. Cancer, 2023, 152(4), 749-760. doi: 10.1002/ijc.34296 PMID: 36121651
  24. Li, Y.; Wang, C.; Xu, M.; Kong, C.; Qu, A.; Zhang, M.; Zheng, Z.; Zhang, G. Preoperative NLR for predicting survival rate after radical resection combined with adjuvant immunotherapy with CIK and postoperative chemotherapy in gastric cancer. J. Cancer Res. Clin. Oncol., 2017, 143(5), 861-871. doi: 10.1007/s00432-016-2330-1 PMID: 28108815
  25. Wang, Y.; Wang, C.; Xiao, H.; Niu, C.; Wu, H.; Jin, H.; Yao, C.; He, H.; Tian, H.; Han, F.; Li, D.; Han, W.; Xu, J.; Chen, J.; Cui, J.; Li, W. Adjuvant treatment combining cellular immunotherapy with chemotherapy improves the clinical outcome of patients with stage II/III gastric cancer. Cancer Med., 2017, 6(1), 45-53. doi: 10.1002/cam4.942 PMID: 27790867
  26. Zhou, C.; Wang, W.; Xie, J.; Zhang, Y.; Yang, Y.; Mu, Y. Efficacy and safety of cord blood-derived dendritic cells plus cytokine-induced killer cells combined with chemotherapy in the treatment of patients with advanced gastric cancer: A randomized Phase II study. OncoTargets Ther., 2016, 9, 4617-4627. doi: 10.2147/OTT.S107745 PMID: 27524915
  27. Chen, Y.; Guo, Z.Q.; Shi, C.M.; Zhou, Z.F.; Ye, Y.B.; Chen, Q. Efficacy of adjuvant chemotherapy combined with immunotherapy with cytokine-induced killer cells for gastric cancer after d2 gastrectomy. Int. J. Clin. Exp. Med., 2015, 8(5), 7728-7736. PMID: 26221323
  28. Gao, D.; Li, C.; Xie, X.; Zhao, P.; Wei, X.; Sun, W.; Liu, H.C.; Alexandrou, A.T.; Jones, J.; Zhao, R.; Li, J.J. Autologous tumor lysate-pulsed dendritic cell immunotherapy with cytokine-induced killer cells improves survival in gastric and colorectal cancer patients. PLoS One, 2014, 9(4), e93886. doi: 10.1371/journal.pone.0093886 PMID: 24699863
  29. Liu, H.; Song, J.; Yang, Z.; Zhang, X. Effects of cytokine-induced killer cell treatment combined with FOLFOX4 on the recurrence and survival rates for gastric cancer following surgery. Exp. Ther. Med., 2013, 6(4), 953-956. doi: 10.3892/etm.2013.1247 PMID: 24137296
  30. Zhao, H.; Fan, Y.; Li, H.; Yu, J.; Liu, L.; Cao, S.; Ren, B.; Yan, F.; Ren, X. Immunotherapy with cytokine-induced killer cells as an adjuvant treatment for advanced gastric carcinoma: A retrospective study of 165 patients. Cancer Biother. Radiopharm., 2013, 28(4), 303-309. doi: 10.1089/cbr.2012.1306 PMID: 23506427
  31. Shi, L.; Zhou, Q.; Wu, J.; Ji, M.; Li, G.; Jiang, J.; Wu, C. Efficacy of adjuvant immunotherapy with cytokine-induced killer cells in patients with locally advanced gastric cancer. Cancer Immunol. Immunother., 2012, 61(12), 2251-2259. doi: 10.1007/s00262-012-1289-2 PMID: 22674056
  32. Jiang, J.T.; Shen, Y.P.; Wu, C.P.; Zhu, Y.B.; Wei, W.X.; Chen, L.J.; Zheng, X.; Sun, J.; Lu, B.F.; Zhang, X.G. Increasing the frequency of CIK cells adoptive immunotherapy may decrease risk of death in gastric cancer patients. World J. Gastroenterol., 2010, 16(48), 6155-6162. doi: 10.3748/wjg.v16.i48.6155 PMID: 21182234
  33. Jiang, J.; Xu, N.; Wu, C.; Deng, H.; Lu, M.; Li, M.; Xu, B.; Wu, J.; Wang, R.; Xu, J.; Nilsson-Ehle, P. Treatment of advanced gastric cancer by chemotherapy combined with autologous cytokine-induced killer cells. Anticancer Res., 2006, 26(3B), 2237-2242. PMID: 16821594
  34. Sumer, F.; Gundogan, E.; Kaplan, K.; Okut, G.; Kayaalp, C. Transvaginal specimen extraction after laparoscopic gastrectomy for tumors. Surg. Laparosc. Endosc. Percutan. Tech., 2022, 32(2), 247-251. doi: 10.1097/SLE.0000000000001031 PMID: 34966150
  35. Hashimoto, I.; Oshima, T. Claudins and gastric cancer: An overview. Cancers, 2022, 14(2), 290. doi: 10.3390/cancers14020290 PMID: 35053454
  36. Lee, J.L.; Kang, Y.K. Capecitabine in the treatment of advanced gastric cancer. Future Oncol., 2008, 4(2), 179-198. doi: 10.2217/14796694.4.2.179 PMID: 18407732
  37. Huynh, J.; Patel, K.; Gong, J.; Cho, M.; Malla, M.; Parikh, A.; Klempner, S. Immunotherapy in gastroesophageal cancers: Current evidence and ongoing trials. Curr. Treat. Options Oncol., 2021, 22(11), 100. doi: 10.1007/s11864-021-00893-6 PMID: 34524553
  38. Högner, A.; Moehler, M. Immunotherapy in gastric cancer. Curr. Oncol., 2022, 29(3), 1559-1574. doi: 10.3390/curroncol29030131 PMID: 35323331
  39. Zhang, L.; Mu, Y.; Zhang, A.; Xie, J.; Chen, S.; Xu, F.; Wang, W.; Zhang, Y.; Ren, S.; Zhou, C. Cytokine-induced killer cells/dendritic cells-cytokine induced killer cells immunotherapy combined with chemotherapy for treatment of colorectal cancer in China: a meta-analysis of 29 trials involving 2,610 patients. Oncotarget, 2017, 8(28), 45164-45177. doi: 10.18632/oncotarget.16665 PMID: 28404886

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