Adrenocortical carcinoma (ACC) is cancer that is uncommon, severe, and has few available treatments. The way many cancers are treated has been transformed by the use of immune checkpoint inhibitors (ICI). Its function in ACC was unknown, though. For a study, researchers sought to summarize the effectiveness of ICI in patients with A; thus, they performed a meta-analysis.
A systematic review was conducted for papers published as meeting abstracts in PubMed, Scopus, CENTRAL, ASCO, and ESMO. The meta-analysis included studies with at least 5 patients that provided overall survival (OS), progression-free survival (PFS), or objective response rate (ORR). Using the fixed-effect model, they calculated the proportions for ORR, disease control rate (DCR), PFS, OS, and adverse events.
Nine trials totaling 168 patients were included. Anti-PD(L)-1 monotherapy was utilized in 6 trials (n=113), anti-PD(L)-1 and anti-CTLA4 combination treatment in 2 studies (n=24), and anti-PD1 coupled with chemotherapy in 2 studies (n=31). The median age of the participants in all trials varied from 43 to 62, and 60.6% were female. For anti-PD(L)-1 monotherapy, the pooled ORR was 10% (95% CI: 4.6%-15.6%, I2 = 0%), for anti-PD(L)-1 and anti-CTLA4 combination treatment, it was 8.7% (95% CI: 0%-20%, I2 = 0%), and it was 9.9% (95% CI: 0%-20.1%, I2 = 0%). For the pooled DCR, anti-PD(L)-1 monotherapy scored at 45.4% (95% CI: 36.3%-54.4%, I2 = 0%), anti-PD(L)-1 and anti-CTLA4 combination treatment scored at 54.9% (95% CI: 34.4%-75.5%, I2 = 0%), and anti-PD1 coupled with chemotherapy scored at 70.5% (95% CI: 26.5%-100%, I2 = 90.3%). For anti-PD(L)-1 monotherapy, the median PFS was 1.88 months (95% CI: 1.08-2.69, I2 = 0%). For additional analysis, there weren’t enough PFS and OS data available. Anti-PD(L)-1 monotherapy resulted in a pooled all grades adverse event rate of 24.0% (95% CI: 12.9%-35.2%, I2 = 92.41%) whereas anti-PD(L)-1 combination with chemotherapy resulted in a 39.1% (95% CI: 9%-69.2%, I2 = 94.7%) rate. Anti-PD(L)-1 monotherapy resulted in grade 3/4 adverse events of 17% (95% CI: 10.1%-24.%, I2 = 0%) while anti-PD1 coupled with chemotherapy resulted in grade 3/4 adverse events of 11.8% (95% CI: 5.5%-18.1%, I2 = 0%).
Compared to single-agent anti-PD(L)-1, combination treatment had a similar ORR and safety profile but a greater DCR. In future combination-based ICI studies, additional survival data should be disclosed because there were few of them.