SynthesisThe oncologist2026
Chemotherapy backbone and outcomes of immune checkpoint inhibitor combinations across solid tumors: a pan-tumor network meta-analysis.
Synthesis in The oncologist, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
13 authors.
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Abstract
backgroundImmune checkpoint inhibitors (ICIs) combined with chemotherapy represent a first-line standard across multiple solid tumors; however, the contribution of chemotherapy backbone to the efficacy of chemo-immunotherapy remains uncertain.
methodsWe conducted a systematic review and network meta-analysis of phase II-III randomized trials comparing ICI-chemotherapy vs chemotherapy alone, with the aim of evaluating whether chemotherapy backbone selection was associated with differences in clinical outcomes across tumor types.
resultsThirty-nine trials including over 30 000 patients were analyzed. Detailed characteristics of included trials by tumor type are reported in Tables S1-S6. Chemo-immunotherapy significantly improved progression-free survival (hazard ratio [HR] 0.69, 95% CI 0.66-0.72) and overall survival (HR 0.78, 95% CI 0.76-0.81). Among the evaluated chemotherapy backbones, platinum-pemetrexed was associated with the greatest relative survival benefit (HR 0.66), followed by platinum-taxane and fluoropyrimidine-platinum regimens (HR 0.78), whereas platinum-gemcitabine showed comparatively lower benefit (HR 0.83). Anti-PD-1 regimens demonstrated numerically greater benefit than anti-PD-L1 therapies, although these findings should be interpreted in light of the non-random distribution of treatment regimens across tumor types. Because chemotherapy backbones were closely linked to tumor-specific standards of care, these differences cannot be interpreted as evidence of superiority across tumor types. All combinations increased grade ≥3 adverse events.
conclusionDifferences in outcomes were observed across chemotherapy backbones; however, these findings likely reflect the combined influence of tumor-specific treatment paradigms, underlying disease biology, and potentially the chemotherapy backbone itself. Therefore, the results should be considered hypothesis-generating and warrant prospective validation within individual tumor types.
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