Efficacy of immune checkpoint inhibitors plus chemotherapy versus chemotherapy-based control in cervical cancer: a meta-analysis.

objectiveAlthough chemotherapy is standard for cervical cancer, the added clinical benefit of immune checkpoint inhibitors compared with chemotherapy-based control strategies remains unclear. This meta-analysis aimed to systematically evaluate the efficacy and safety of immune checkpoint inhibitors combined with chemotherapy versus chemotherapy-based control regimens in patients with cervical cancer, synthesizing evidence across randomized and non-randomized studies to inform clinical decision-making and future research.

methodsWe systematically searched for eligible comparative studies evaluating immune checkpoint inhibitors combined with chemotherapy versus chemotherapy-based control regimens in patients with cervical cancer. The primary outcomes were progression-free survival (PFS) and overall survival (OS), while secondary outcomes included treatment response, adverse events, subgroup effects, and publication bias. Hazard ratios (HRs) and risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using standard meta-analytic methods, and study quality was assessed using the Cochrane risk-of-bias framework.

resultsCompared with chemotherapy-based control strategies, neoadjuvant immune checkpoint inhibitors plus chemotherapy significantly improved progression-free survival (HR, 0.60; 95% CI, 0.47-0.72) and overall survival (HR, 0.64; 95% CI, 0.55-0.73). Improvements in OS and PFS were generally consistent across most predefined subgroups, including age, ECOG performance status, race, chemotherapy backbone, disease status, and prior chemoradiotherapy exposure. In contrast, the addition of immunotherapy did not significantly increase the incidence of overall adverse events (RR, 1.02; 95% CI, 0.94-1.10) or decreased white blood cell count (RR, 0.88; 95% CI, 0.63-1.23). For response outcomes, complete response showed a borderline improvement (RR, 1.17; 95% CI, 0.99-1.37), stable disease was significantly reduced (RR, 0.73; 95% CI, 0.59-0.91), whereas partial response, objective response rate, and disease control rate were not significantly different between groups. Funnel-plot assessment suggested no major publication bias, although a moderate risk of small-study effects could not be excluded.

conclusionImmune checkpoint inhibitors combined with chemotherapy appear superior to chemotherapy-based control regimens for cervical cancer, demonstrating significant improvements in progression-free and overall survival, along with indications of deeper tumor response.