Effectiveness of anti-PD-1/PD-L1 antibodies in urothelial carcinoma patients with different PD-L1 expression levels: a meta-analysis
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Junqi Liu1,*, Chuanfeng Zhang1,*, Jiegang Hu1, Qing Tian1, Xin Wang1, Hao Gu1, Song Zhang1, Di Zhao2 and Ruitai Fan1
1Department of Radiotherapy, The First Affiliated Hospital of Zhengzhou University, 450000 Zhengzhou, Henan, China
2Endocrinology Department, The First Affiliated Hospital of Zhengzhou University, 450000 Zhengzhou, Henan, China
*These authors contributed equally to this work
Ruitai Fan, email: firstname.lastname@example.org
Keywords: programmed death-1 (PD-1); programmed death-ligand 1 (PD-L1); urothelial carcinoma; meta-analysis
Received: September 18, 2017 Accepted: December 05, 2017 Published: January 13, 2018
Background: Urothelial carcinoma ranks the ninth among malignant cancers. We conducted this study to identify which patients could benefit more from the treatment of programmed death-1 (PD–1)/programmed death-ligand1 (PD–L1) inhibitors.
Materials and Methods: We performed literature searches, combined data from qualified literature and performed comparative analyses on the effectiveness of anti-PD–1/PD–L1 antibodies in patients with different PD–L1 expression levels.
Results: We divided patients into three groups according to the percentages of PD–L1-positive cells, namely the low- PD-L1 (PD-L1 < 1%), the medium-PD-L1 (PD-L1 ≥ 1 and < 5%) and the high–PD–L1 (PD-L1 ≥ 5%) groups. We found that the high-PD-L1 group responded significantly better than other groups (P = 0.0003, ORs = 0.45, 95%CI: 0.29-071; P = 0.0009, ORs = 0.43, 95%CI: 0.25-0.73, for low-PD-L1 and medium-PD-L1 groups, respectively), while the latter two groups responded similarly (P = 0.90, ORs = 1.06, 95%CI: 0.62-1.83) to both PD–1 and PD–L1 inhibitors. Furthermore, we found that the medium-PD–L1 and high-PD–L1 groups responded similarly to PD-1/ PD-L1 inhibitors (P = 0.65, ORs = 1.11, 95%CI: 0.69–1.77), while the low-PD–L1 group responded better to PD-1 inhibitors than PD-L1 inhibitors (P = 0.046, ORs = 1.92, 95%CI: 0.98–3.89).
Conclusions: Our results suggest that PD–L1 positive patients should be defined as those with ≥ 5% or greaterPD-L1-positive cells. PD-1 antibodies performed better only in the low-group patients, likely because they could block the interactions of PD–1 with both PD–L1 and PD–L2.
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