Abstract 4P
Background
Adrenocortical carcinoma (ACC) is a rare and aggressive malignancy with few treatment options. The use of immune checkpoint inhibitors (ICI) has revolutionized the way many malignancies are treated. However, its role in ACC is still unclear. Thus, we performed a meta-analysis to summarize the efficacy of ICI in patients with ACC.
Methods
A systematic review was performed for studies published in PubMed, Scopus, CENTRAL, ASCO, and ESMO meeting abstracts. Studies that reported overall survival (OS), progression-free survival (PFS), or objective response rate (ORR) and were with at least 5 patients were included in the meta-analysis. We estimated the proportions for ORR, disease control rate (DCR), PFS, OS and adverse events using the fixed-effect model.
Results
We included 9 studies with a total number of 168 patients. Six studies used anti-PD(L)-1 monotherapy (n=113), 2 studies used anti-PD(L)-1 and anti-CTLA4 combination therapy (n=24) and 2 studies used anti-PD1 combined with chemotherapy (n=31). Patients’ median age across studies ranged from 43 to 62 with 60.6% being females. The pooled ORR was 10% (95% CI: 4.6%-15.6%, I2 = 0%) for anti-PD(L)-1 monotherapy, 8.7% (95% CI: 0%-20%, I2 = 0%) for anti-PD(L)-1 and anti-CTLA4 combination therapy, and 9.9% (95%CI: 0%-20.1%, I2 = 0%). For the pooled DCR, it was 45.4% (95% CI: 36.3%-54.4%, I2 = 0%) for anti-PD(L)-1 monotherapy, 54.9% (95% CI: 34.4%-75.5%, I2 = 0%) for anti-PD(L)-1 and anti-CTLA4 combination therapy, and 70.5% (95%CI: 26.5%-100%, I2 = 90.3%) for anti-PD1 combined with chemotherapy. The median PFS was 1.88 months (95%CI: 1.08-2.69, I2 = 0%) for anti-PD(L)-1 monotherapy. The was not enough data regarding PFS and OS for further analyses. Pooled all grades adverse events were 24.0% (95%CI: 12.9%-35.2%, I2 = 92.41%) for anti-PD(L)-1 monotherapy and 39.1% (95%CI: 9%-69.2%, I2 = 94.7%) for anti-PD1 combined with chemotherapy. Grade 3/4 adverse events were 17% (95%CI: 10.1%-24.%, I2 = 0%) for anti-PD(L)-1 monotherapy and 11.8% (95%CI: 5.5%-18.1% , I2 = 0%) for anti-PD1 combined with chemotherapy.
Conclusions
Combination therapy showed a similar ORR and safety profile but higher DCR compared to single-agent anti-PD(L)-1. Survival data were scarce and should be reported more in future combination-based ICI trials.
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.