The authors used a systematic review of Medline, EMBASE, Web of Science, and the Cochrane Database between January 2000 and October 2019 to identify randomized controlled trials of combined immunotherapy and chemotherapy versus chemotherapy alone in patients with advanced or metastatic solid organ malignancies. The primary outcome of interest was severe adverse events (grade 3 or greater) with secondary outcomes including all-grade adverse events, treatment discontinuation due to adverse events, and death due to adverse events. The authors performed a random-effects meta-analysis to pool results.
Among a literature search of 3845 references, 13 relevant studies were identified involving 6836 patients. Included trials examined patients with non-small cell lung cancer, small cell lung cancer, triple-negative breast cancer, and melanoma who were treated with ipilimumab, atezolizumab, pembrolizumab, or nivolumab in addition to standard chemotherapy.
Among patients receiving combined chemoimmunotherapy, serious adverse events were more common (57%) than among those receiving chemotherapy alone (45%), odds ratio 1.57, 95% confidence interval 1.27 to 1.95.
Similarly, any grade adverse events, termination of therapy due to adverse events, and treatment-related death were more common among patients receiving chemoimmunotherapy.
Finally, the authors assessed immune-specific side effects which were even more strongly associated with the use of chemoimmunotherapy.
Thus, the authors conclude that the potential benefits of combined chemoimmunotherapy must be carefully weighed against this observed increase in toxicity.
Presented by: Marybeth Hall, MD, Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
Written by: Christopher J.D. Wallis, MD, Ph.D., Instructor in Urology, Vanderbilt University Medical Center, Nashville, Tennessee @WallisCJD on Twitter at the 2020 Society of Urologic Oncology Annual Meeting – December 2-5, 2020 – Washington, DC