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Toxicity patterns associated with chemotherapy/immune checkpoint inhibitor combinations: a meta-analysis
1Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Immunotherapy
|May 29, 2019
Summary
Adding immune checkpoint inhibitors to chemotherapy does not significantly increase high-grade hematological or gastrointestinal toxicities, except for a higher risk of severe diarrhea. This finding is crucial for understanding combination cancer therapy safety profiles.
Area of Science:
- Oncology
- Clinical Pharmacology
- Evidence-Based Medicine
Background:
- Immune checkpoint inhibitors (ICIs) combined with chemotherapy represent a significant advancement in cancer treatment.
- Understanding the toxicity profiles of these combinations is essential for clinical decision-making and patient safety.
Purpose of the Study:
- To systematically evaluate and clarify the toxicity patterns of combining chemotherapy with immune checkpoint inhibitors.
- To assess the risk of specific high-grade adverse events associated with these combination regimens.
Main Methods:
- A meta-analysis of randomized controlled trials comparing chemotherapy with or without ICIs (pembrolizumab, nivolumab, atezolizumab, durvalumab, avelumab).
- Relative risk (RR) was used as the primary summary statistic to compare toxicity rates.
- Eleven eligible studies were included in the final analysis.
Main Results:
- No significant increase in high-grade anemia (RR 0.98), thrombocytopenia (RR 1.10), or neutropenia (RR 0.96) was observed.
- High-grade nausea (RR 1.19) and vomiting (RR 1.09) showed no significant increase.
- A significant increase in high-grade diarrhea was noted (RR 2.61, p=0.002).
Conclusions:
- The addition of ICIs to chemotherapy does not generally elevate the risk of severe hematological toxicities.
- Most gastrointestinal toxicities, apart from diarrhea, are not significantly increased by ICI combination therapy.
- Clinicians should be particularly vigilant for and manage high-grade diarrhea when using chemotherapy and ICI combinations.
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