Evaluating the synergistic impact of PD-1/PD-L1 blockade and platinum-based chemotherapy in modulating the tumor microenvironment for enhanced T cell-mediated immune responses in advanced endometrial cancer: a meta-analysis

Endometrial cancer (EC) is a common malignancy of the female reproductive system with rising incidence worldwide. Advanced EC has poor prognosis, with limited options beyond platinum-based chemotherapy. Immune checkpoint inhibitors (ICIs), targeting Programmed Cell Death Protein 1 (PD-1)/Programmed Cell Death Ligand 1 (PD-L1), show promise in improving outcomes. This meta-analysis evaluates the efficacy and safety of combining ICIs with platinum-based chemotherapy as first-line treatment for advanced EC. Five studies (1150 patients) were analyzed using data from PubMed, Embase and Cochrane databases. The pooled hazard ratio (HR) for progression-free survival (PFS) was 0.65 (95% confidence intervals (CI): 0.53–0.80), indicating a 35%reduction in progression or death risk. Subgroup analysis showed greater efficacy in mismatch repair deficient (dMMR) tumors (HR: 0.34, 95% CI: 0.27–0.44) compared to mismatch repair proficient (pMMR) tumors (HR: 0.73, 95% CI: 0.65–0.80). Adverse events were comparable between groups, but immune-related events were more common in combination therapy. These findings suggest that adding ICIs to chemotherapy improves PFS, particularly in dMMR patients, supporting their integration into first-line treatment for advanced EC. Further research is needed to optimize strategies. Registration: INPLASY202490121.

Endometrial cancer; Platinum-based chemotherapy; Immune checkpoint inhibitors; Anti-PD-1; Meta-analysis

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