Immunotherapy versus chemotherapy for solid tumours: lower risk of AEs
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Immunotherapy versus chemotherapy for solid tumours: lower risk of AEs Immunotherapy is associated with a lower risk of adverse events (AEs) than chemotherapy in patients with advanced solid tumours, according to findings of a systematic review and meta-analysis published in Annals of Oncology. Embase, Medline (Pubmed), Web of Science and Cochrane databases were searched for randomised controlled trials comparing immunotherapy with chemotherapy (standard of care) in adults with advanced or metastatic solid tumours which were published between January 2000 and February 2019. Immunotherapy included cytotoxic Tlymphocyte antigen-4 (CTLA-4) inhibitors (ipilimumab or tremelimumab); programmed cell death 1 receptor (PD-1) antagonists (nivolumab or pembrolizumab); and programmed cell death-1 ligand-1 (PD-L1) inhibitors (atezolizumab, avelumab or durvalumab). A total of 22 studies in 12 727 patients met the inclusion criteria. Immunotherapy was associated with a lower risk of grade 3 AEs than chemotherapy (16.5% vs 41.09%; odds ratio [OR] 0.26; 95% CI 0.19, 0.35), as well as lower risks of developing any AE (OR 0.35; 95% CI 0.28, 0.44), discontinuing therapy due to an AE (OR 0.55; 95% CI 0.39, 0.78) and death due to a treatment-related AE (OR 0.67; 95% CI 0.46, 0.98). Patients receiving immunotherapy had a lower incidence of fatigue (15.8% vs 25.1%), diarrhoea (11.1% vs 15.0%) and acute kidney injury (1.3% vs 1.8%) than those receiving chemotherapy, but had a higher incidence of colitis (1.0% vs 0.3%), pneumonitis (3.4% vs 0.4%) and hypothyroidism (6.8% vs 0.4%). "We found that immunotherapy was associated with a significant reduction in the likelihood of developing severe, and any, AEs compared with chemotherapy. In addition, patients receiving immunotherapy had reduced odds of death from an AE compared with standard-of-care chemotherapy," concluded the authors. However, "AEs with immunemediated mechanisms are more common in patients treated with immunotherapy and require formal clinical monitoring," they commented. Magee DE, et al. Adverse event profile for immunotherapy agents compared with chemotherapy in solid organ tumors: a systematic review and meta-analysis of randomized 803448505 clinical trials. Annals of Oncology 31: 50-60, No. 1, Jan 2020. Available from: URL: http://doi.org/10.1016/j.annonc.2019.10.008
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Reactions 18 Jan 2020 No. 1787
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