381MO - Progression free survival and overall survival in platinum-based chemotherapy alone versus immune checkpoint inhibitor (ICI)-platinum-based chemotherapy combination in first-line treatment for advanced, metastatic or recurrent endometrial adenocarcinoma: A meta-analysis

Background

Combination of immune checkpoint inhibitors (ICIs) with platinum-based chemotherapy has exhibited a paradigm shift in first-line treatment for advanced or recurrent endometrial adenocarcinoma. The objective of this meta-analysis is to evaluate the superiority of this combination versus standard platinum-based chemotherapy in terms of overall survival (OS) and progression free survival (PFS).

Methods

Eligible studies were randomized controlled trials (RCTs) of patients more than 18 years old with pathologically confirmed endometrial cancer who underwent first line combination ICI-platinum chemotherapy in the advanced, metastatic or recurrent setting. Those excluded from the analysis were studies with no standard platinum-based chemotherapy arm. Case-series, case reports, and observational studies were also excluded. Primary outcome of progression free survival (PFS) and overall survival (OS) were analyzed.

Results

Six randomized controlled trials enrolling 2,995 patients with advanced endometrial adenocarcinoma were identified. Four of these studies conducted an exploratory subgroup analysis between mismatch repair (MMR)-deficient (dMMR) and MMR-proficient (pMMR) patients. The evidence of this meta-analysis reveal that the addition of ICIs to platinum-based chemotherapy significantly improved progression free survival (PFS) compared to chemotherapy alone (pooled HR 0.6, 95% CI 0.60-0.72, p-value 0.0001, I-squared 78%). This PFS benefit was evident across the dMMR (pooled HR 0.36, 95% CI 0.26-0.50, p-value 0.0001, I-squared 0%) and pMMR (pooled HR 0.60, 95% CI 0.51-0.70, p-value 0.0001, I-squared 40%) subgroups. The addition of checkpoint inhibitors was also associated with prolonged OS (pooled HR 0.69, 95% CI 0.57-0.83, p-value 0.0001, I-squared 41%).

Conclusions

Checkpoint inhibitors plus chemotherapy compared with chemotherapy alone is associated with prolonged OS and PFS in the first-line setting for advanced endometrial adenocarcinoma. This benefit was significant for both the dMMR and pMMR patient cohort.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.