Evidence map›Paper›PMID 40597782›Full record

SynthesisBMC cancer2025

Neoadjuvant chemoradiotherapy with or without PD-1/PD-L1 inhibitors in locally advanced rectal cancer: a systematic review and meta-analysis.

Muhammad Ansab, Sepideh Razi, Farwa Nisa, Eiman Araib, Shree Rath, Iqra Khan, Noor Ul Huda Ramzan, Esha Dilawar, Anwaar Saeed

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMC cancer, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Review
  4. Review
  5. Article
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Muhammad AnsabFaculty of Medicine, Services Institute of Medical Sciences, Lahore, Pakistan.
Sepideh RaziResearch Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
Farwa NisaFaculty of Medicine, Fatima Jinnah Medical University, Lahore, Pakistan.
Eiman AraibFaculty of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
Shree RathFaculty of Medicine, All India Institute of Medical Sciences, Bhubaneswar, India.
Iqra KhanFaculty of Medicine, Services Institute of Medical Sciences, Lahore, Pakistan.
Noor Ul Huda RamzanFaculty of Medicine, University Medical and Dental College, Lahore, Pakistan.
Esha DilawarFaculty of Medicine, Services Institute of Medical Sciences, Lahore, Pakistan.
Anwaar SaeedDepartment of Medicine, Division of Hematology & Oncology, University of Pittsburgh Medical Center (UPMC), 5150 Centre Ave, Pittsburgh, PA, 15213, USA. saeeda3@upmc.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundLocally advanced rectal cancer (LARC) represents a pivotal stage of rectal cancer where it is possible to completely cure the cancer before its systemic spread, thus often requiring an aggressive multimodal therapy. Recent trials suggest that programmed cell death protein 1 (PD-1)/programmed cell death ligand 1 (PD-L1) inhibitors combined with neoadjuvant chemoradiotherapy (CRT) may improve treatment outcomes. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of PD-1/PD-L1 inhibitors when integrated into neoadjuvant CRT regimens for LARC patients.

methodsA systematic search of PubMed, Embase, ClinicalTrials.gov, and Cochrane Central Library was conducted up to October 11, 2024. Randomized controlled trials (RCTs) comparing neoadjuvant CRT with or without PD-1/PD-L1 inhibitors were included. The primary outcomes assessed were pathological complete response (pCR), clinical complete response (cCR), and serious adverse events (SAEs). Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Subgroup analyses were performed to explore variations in radiotherapy strategies, types of PD-1/PD-L1 inhibitors used, and mismatch repair (MMR) status.

resultsSix RCTs (861 patients) met the inclusion criteria. PD-1 inhibitors significantly improved pCR rates (OR = 2.10, 95% CI: 1.32-3.32, p = 0.001), particularly with short-course radiotherapy (SCRT) and agents like Camrelizumab and Tislelizumab. However, PD-1 inhibitors did not significantly enhance cCR (OR = 1.54, 95% CI: 0.51-4.63, p = 0.44) or increase SAEs (OR = 1.08, 95% CI: 0.73-1.60). Subgroup analysis based on MMR status revealed a significantly higher pCR rate in the proficient MMR (pMMR) subgroup compared to the deficient MMR (dMMR) subgroup, although the result for dMMR was non-significant due to limited sample size and the absence of reported events.

conclusionsThe addition of PD-1 inhibitors to neoadjuvant CRT significantly improves pCR rates in LARC without increasing toxicity. These findings support their potential role in standard treatment protocols, warranting further phase III trials. REGISTRATION NUMBER: CRD42024619949.

Indexed as

ChemoradiotherapyChemoradiotherapy, AdjuvantImmune Checkpoint InhibitorsNeoadjuvant TherapyProgrammed Cell Death 1 ReceptorRectal NeoplasmsB7-H1 AntigenHumansRandomized Controlled Trials as TopicTreatment OutcomeB7-H1 AntigenCD274 protein, humanImmune Checkpoint InhibitorsPDCD1 protein, humanProgrammed Cell Death 1 ReceptorClinical complete responseImmunotherapyLocally advanced rectal cancerNeoadjuvant chemoradiotherapyPathological complete responsePD-1 inhibitorsShort-course radiotherapy

Identifiers

PMID40597782
PMCPMC12211167

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.