Meta-Analysis of Efficacy and Safety of Karelizumab Combined with Apatinib in the Treatment of Advanced Gastric Cancer

Abstract

Objective. To systematically evaluate the clinical efficacy and safety of karelizumab combined with apatinib in the treatment of advanced gastric cancer. Methods. The published databases were searched by computer, Chinese: China Biomedical Literature Database (CBM), Wanfang Journal Database, China national knowledge infrastructure (CNKI), and China Science and Technology Journal Database (VIP); English: Embase, Cochrane library, and PubMed. The search time is from the establishment of the database to May 2022, and clinical randomized controlled trials (RCT) with advanced gastric cancer as the research object and karelizumab combined with apatinib as the research variables are collected. According to the bias risk evaluation standard of Cochrane System Evaluator’s Manual, the literatures meeting the inclusion standard were evaluated for bias risk, and the meta-analysis was conducted by Review Manager 5.3. Results. A total of 20 articles with 1150 patients were included in this study. All the included 20 articles reported objective remission rate (ORR), and the heterogeneity among 20 studies was low ( P > 0.05 , I 2 = 0 %). The ORR of gastric cancer patients in the observation group was significantly higher than that in the blank group [odds ratio OR = 1.97 , 95% CI [1.53, 2.62], P < 0.01 ). All the included 20 articles reported disease control rate (DCR), and the heterogeneity among 20 studies was low ( P = 0.87 , I 2 = 0 %). The ORR of gastric cancer patients in the observation group was significantly higher than that in the blank group ( OR = 3.09 , 95% CI [2.29, 4.16], P < 0.01 ). Three articles in the included literature reported the median OS, and the heterogeneity among the three studies was low ( P = 0.70 , I 2 = 0 %). The median OS of gastric cancer patients in the observation group was significantly higher than that in the blank group ( MD = 3.97 , 95% CI [3.61, 4.39], P < 0.01 ). There are three reports on median progression-free survival (PFS) in the included literature, and there is high homogeneity among the three studies ( P < 0.00001 , I 2 = 86 %). There is no statistical difference between the median PFS of gastric cancer patients in the observation group and the blank group ( MD = 1.21 , 95% CI [−1.20, 3.70], P = 0.29 ). The incidence of hypertension in the observation group was significantly higher than that in the blank group [ OR = 6.19 , 95% CI (1.91, 20.20), P = 0.003 ]. The incidence of proteinuria in the observation group was significantly higher than that in the blank group [ OR = 3.97 , 95% CI (1.08, 14.59), P = 0.03 ]. There was no significant difference in the incidence of other adverse reactions such as hand-foot syndrome, diarrhea, and myelosuppression between the observation group and the blank group. The levels of IFN-γ and TNF-α in the observation group were significantly higher than those in the blank group ( P < 0.0001 ). The levels of IL-10, IL-4, and tumor markers in the observation group were significantly lower than those in the blank group ( P < 0.05 ). Egger’s test showed that there was no publication bias in the 20 included studies ( P > 0.05 ). Conclusion. Karelizumab combined with apatinib is effective in the treatment of advanced gastric cancer, with low incidence of adverse reactions and high safety. However, a large number of multicenter, large sample size, and high-level RCT are needed for clinical verification.

The efficacy and safety of apatinib combined with S-1 for advanced gastric cancer: A systematic review and meta-analysis

“…The low heterogeneity, inconsistencies, and good model fitting between the experiments further confirmed the robustness and accuracy of the results. In terms of clinical effectiveness, 26 rigorous randomized trials confirmed that apatinib was the most effective regimen in combination with S-1, both in terms of overall effectiveness and disease control, which is consistent with the conclusions of previous clinical trials, [16,54] so widespread adoption of this strategy makes sense. The benefit of the treatment regimen on quality of life was complemented in this study, 7 and 8 studies followed participants for SP and PFS, respectively.…”

The efficacy of TP chemotherapy combined with karelizumab on the postoperative clinical status of patients with advanced ovarian cancer

“…The combination of karelizumab with TP chemotherapy did not significantly increase adverse reactions, thus indicating that karelizumab was relatively safe; the main reason for this is that only a short period of treatment was required. During drug treatment, patients did not experience serious adverse reactions and the negative effects of this treatment on patients was within the tolerable range [24,25].…”

Effect of anlotinib combined with camrelizumab on clinical efficacy and short-term prognosis in male patients with advanced gastric cancer

“…Clinical studies have demonstrated its effectiveness in prolonging overall survival for patients with various tumor types compared to conventional chemotherapy. Additionally, camrelizumab exhibits the lowest toxicity among immune-targeted agents when used in second-or third-line treatment regimens [26,27].…”