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Immune checkpoint inhibitor combinations for patients with advanced endometrial cancer: a network meta-analysis and cost-utility analysis
  1. Youwen Zhu1,
  2. Kun Liu1 and
  3. Hong Zhu1,2
    1. 1Department of Oncology, Xiangya Hospital Central South University, Changsha, Hunan, China
    2. 2National Clinical Research Center for Geriatric Disorders, Xiangya Hospital Central South University, Changsha, Hunan, China
    1. Correspondence to Professor Hong Zhu, Department of Oncology, Xiangya Hospital Central South University, Changsha 410008, Hunan, China; zhuhong719{at}csu.edu.cn

    Abstract

    Background Immune checkpoint inhibitor combinations show significant survival advantages compared with chemotherapy for patients with advanced endometrial cancer.

    Objective To compare the efficacy, safety, and cost-effectiveness of different immunotherapy combinations for clinician and patient decision-making.

    Methods The PubMed, Embase, Cochrane, and Web of Science Databases were reviewed from January 1, 2010 to October 30, 2023, for phase III randomized controlled trials of first-line immunotherapy combinations in patients with advanced endometrial cancer. Bayesian network meta-analysis was performed to obtain hazard ratios (HRs) of overall survival and progression-free survival, relative risks (RRs) of adverse events, and corresponding p value. The lifetime Markov model of cost-effectiveness analysis was developed to summarize the cost, life-years, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios at the US$150 000/QALY of willingness-to-pay of six first-line treatment strategies.

    Results Four trials were identified, involving 2577 patients. Dostarlimab plus chemotherapy or durvalumab plus chemotherapy with olaparib was associated with more survival benefits than other immunotherapy regimens and chemotherapy in the mismatch repair-deficient microsatellite instability-high (dMMR/MSI-H) and mismatch repair-proficient microsatellite-stable (pMMR/MSS) population, respectively. Further, pembrolizumab plus chemotherapy versus chemotherapy increased efficacy (cost) by 3.76 QALYs and US$540 817, which yielded incremental cost-effectiveness ratios of US$143 894/QALY in the dMMR/MSI-H population.

    Conclusion First-line durvalumab plus chemotherapy with olaparib, and dostarlimab plus chemotherapy, were more beneficial for survival in the pMMR/MSS and dMMR/MSI-H populations, respectively. Only pembrolizumab plus chemotherapy versus chemotherapy was cost-effective for patients with dMMR/MSI-H endometrial cancer in the USA.

    • Uterine Cancer
    • Endometrial Neoplasms
    • Medical Oncology

    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information. All authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and accuracy of the data analysis. The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information. All authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and accuracy of the data analysis. The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

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    Footnotes

    • Contributors HZ: Conceptualization, methodology, software, resources, data curation, writing-original draft, and writing-review and editing, supervision, project administration, and funding acquisition. YZ: Conceptualization, methodology, validation, formal analysis, investigation, writing-original draft, and writing-review and editing, and visualization. KL: Conceptualization, methodology, validation, formal analysis, investigation, writing-original draft, and writing-review and editing. HZ is responsible for the overall content as guarantor. All authors have read and approved the manuscript.

    • Funding This work was partly supported by the Clinical Research Project of Xiangya Hospital (grant/award number: 2016L06 to HZ) and the Changsha Natural Science Foundation of Hunan Provincial of China (grant/award number: kq2208376 to HZ).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.