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Patients with gastric cancer have better outcomes of immune checkpoint inhibitor (ICI) treatment if they have a high tumor mutational burden (TMB), according to a meta-analysis published in International Immunopharmacology.
Researchers found that overall survival (OS) and progression-free survival (PFS) were longer in patients with a high TMB, and these benefits were drive by Asian patients.
This meta-analysis included 11 retrospective studies of patients with gastric or gastroesophageal cancer treated with ICIs. Nine studies were conducted in Asian countries and 2 in non-Asian countries.
Patients received combination treatment in 6 studies and ICI monotherapy in 5 studies. The ICIs included nivolumab, pembrolizumab, atezolizumab, tislelizumab, and toripalimab.
Using data from 8 studies, the researchers found that patients with a high TMB had significantly longer OS than patients with a low TMB (hazard ratio [HR], 0.65; 95% CI, 0.55-0.77; P <.001).
Using data from 10 studies, the researchers found that patients with a high TMB had significantly longer PFS than patients with a low TMB (HR, 0.51; 95% CI, 0.33-0.77; P =.001).
A subgroup analysis revealed that the OS benefit was significant in Asian patients with a high TMB (HR, 0.56; 95% CI, 0.43-0.72; P <.001) but not in non-Asian patients with a high TMB (HR, 0.61; 95% CI, 0.32-1.16; P =.133).
Similarly, the PFS benefit was significant in Asian patients with a high TMB (HR, 0.45; 95% CI, 0.28-0.72; P =.001) but not in non-Asian patients with a high TMB (HR, 0.68; 95% CI, 0.31-1.48; P =.322).
The OS in high-TMB patients was similar whether they received combination therapy or monotherapy. The PFS benefit, on the other hand, was significant in high-TMB patients who received monotherapy (HR, 0.39; 95% CI, 0.22-0.67; P =.001) but not in those who received combination therapy (HR, 0.84; 95% CI, 0.65-1.08; P =.192).
“This meta-analysis demonstrated that gastric cancer patients with high TMB showed significant benefits from ICIs compared to … low TMB patients, particularly in Asian populations,” the researchers wrote. “In the future, there is a requirement for a large number of RCTs [randomized clinical trials] to prove that TMB is a feasible predictor for prognosis of gastric cancer patients treated with ICIs.”
Reference
Ke L, Li S, Huang D. The predictive value of tumor mutation burden on survival of gastric cancer patients treated with immune checkpoint inhibitors: A systematic review and meta-analysis. Int Immunopharmacol. 2023;124(Part B):110986. doi:10.1016/j.intimp.2023.110986
This article originally appeared on Cancer Therapy Advisor
