Safety and efficacy of atezolizumab in the treatment of cancers: a systematic review and pooled-analysis

Abstract

Purpose

Immune checkpoint inhibitors have developed rapidly and have demonstrated antitumor activity in various cancers. To evaluate the safety and efficacy of atezolizumab in treating cancers, we conducted this meta-analysis.

Methods

Embase, PubMed, MEDLINE, the Central Register of Controlled Trials of the Cochrane Library, and the American Society of Clinical Oncology database were searched for relevant studies. The primary outcomes were any grade adverse events (AEs) and grade ≥3 AEs. The secondary outcomes were overall objective response rate, pooled 6-month progression-free survival (PFS) rate, 1-year overall survival (OS) rate, median PFS, and median OS.

Results

Our meta-analysis was based on 14 clinical trials with 3,266 patients. The total risk of any grade AEs reached 69%, while grade ≥3 AEs happened in only 13% of participants. The overall atezolizumab-related death rate was 0.17%. Major common AEs involved fatigue (24.5%), decreased appetite (13.2%), nausea (12.3%), diarrhea (10.8%), pyrexia (10.7%), pruritus (9.6%), cough (9.5%), edema peripheral (8.6%), and rash (8.4%). The most common severe AEs were fatigue (2.2%), anemia (1.9%), and dyspnea (1.9%). Meanwhile, we found that 6% patients reached complete response and 16% partial response. The pooled 6-month PFS rate and 1-year OS rate were 0.36 (95% CI: 0.31–0.41) and 0.55 (95% CI: 0.49–0.61), respectively. The median PFS varied from 1.5 to 6.1 months, and the median OS ranged from 5.9 to 28.9 months.

Conclusion

Atezolizumab has a considerable potential in treating cancers with an acceptable risk profile.

Keywords:

• atezolizumab
• safety
• efficacy
• cancer
• meta-analysis

Supplementary materials

Figure S1 The risk of bias graph and the risk of bias summary.

Notes: Blinding of participants and personnel was not evaluated as low-risk item because some studies were dose-escalation and single-arm trials. The overall risk of bias was evaluated as low risk. The risk of bias graph (A) and the risk of bias summary (B).

Table S1 PFS and OS of control-arm trials and single-arm trials

Table S2 Results of subgroup analysis

Acknowledgments

This study was supported by the National Natural Science Foundation of China (number 81572850).

Author contributions

YT collected and analyzed the data and wrote the article. HY and RZ performed study selection and quality assessment. HZ edited the pictures. DY and JZ performed manuscript modification. ML provided the idea. All authors contributed toward data analysis, drafting and revising the paper, gave final approval of the version to be published and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.