This study, based on a systematic review of phase III randomized controlled trials, reveals that combination immunotherapy and chemotherapy (Chemo-IO) significantly elevate the risk of treatment discontinuation due to treatment-related adverse events (TRAEs) compared to monotherapy (mono-IO).
The following is a summary of “Discontinuation risk from adverse events: immunotherapy alone vs. combined with chemotherapy: a systematic review and network meta-analysis,” published in the January 2024 issue of Oncology by Shin et al.
This study investigates the comparative rates of treatment discontinuation between combination immunotherapy and chemotherapy (Chemo-IO) and monotherapy (mono-IO) as initial treatments for various solid tumors. Conducting a systematic review of phase III randomized controlled trials published between January 1, 2018, and July 10, 2023, retrieved from databases like PubMed, Embase, Cochrane Library, and others, the analysis involved 29 trials, encompassing 21,677 patients and five treatment types.
Employing the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines and a random effects model for network meta-analysis, the study assessed the risk of bias using the Cochrane risk-of-bias tool II. The primary focus was on treatment discontinuation rates attributed to treatment-related adverse events (TRAEs) in patients undergoing immunotherapy, either alone or in combination with chemotherapy. The findings revealed that Chemo-IO significantly increased the risk of discontinuation due to TRAEs compared to mono-IO, with a notable impact on non-small cell lung cancer (NSCLC) patients. Subsequent analyses exploring discontinuation rates related to treatment-emergent adverse events (TEAEs) or any adverse events (AEs) irrespective of causality consistently underscored the heightened risk associated with Chemo-IO.
The study concludes that while Chemo-IO is associated with increased discontinuation risks, understanding this risk dichotomy is crucial for tailoring treatment strategies to individual patient needs. Further research is essential to identify and characterize subsets of patients who may derive greater benefits from mono-IO, considering the potential impact of treatment duration on clinical outcomes.
Source: bmccancer.biomedcentral.com/articles/10.1186/s12885-024-11897-4