Gastro Hep Advances 2026 - Systematic Reviews and Meta-Analysis - Efficacy and Safety of Anti-PD-(L)1 Treatments: A Systematic Review and Meta-Analysis of Asian vs Non-Asian Patients with Esophageal Squamous Cell Carcinoma

Sep 29, 2026

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Esophageal squamous cell carcinoma is highly prevalent in Asia, and anti-PD-(L)1 therapies have become a standard treatment for advanced or metastatic disease. Because many randomized trials were conducted in Asian populations, applicability to non-Asian patients remained uncertain. A meta-analysis combined first- and second-line randomized controlled trials, evaluating overall survival by Asian versus non-Asian subgroups and testing heterogeneity and stability through sensitivity analyses. Results showed no significant overall survival difference between Asian and non-Asian patients, supporting regulatory and health technology assessment decisions and broader guideline consideration.

LanguageEnglish

CategoryHealthcare

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Pages18

Reading Time45 min

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Background and Aims

Methods

Results

Conclusion

Keywords

Gastro Hep Advances 2026;5:100843 SYSTEMATIC REVIEWS AND META-ANALYSIS Efficacy and Safety of Anti-PD-(L)1 Treatments: A Systematic Review and Meta-Analysis of Asian vs Non-Asian Patients with Esophageal Squamous Cell Carcinoma Jaffer Ajani,1 Lin Zhan,2 Alysha Kadva,3 Ken Kato,4 Julian Kretz,5 Filippo Pietrantonio,6 Ronan J. Kelly,7 Xiaowei Zhang,2 and Sylvie Lorenzen8 1Medical Oncologist, Department of Gastrointestinal (GI) Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas; 2Statistician, BeOne Medicines, Ltd., Emeryville, California; 3Clinical Development, BeOne Medicines, Ltd., Ridgefield Park, New Jersey; 4Chief of Department of Head and Neck Medical Oncology, National Cancer Center Hospital, Tokyo, Japan; 5Scientific Director – Solid Tumors, Global Medical Affairs (ex-China), BeOne Medicines, Ltd., Basel, Switzerland; 6Medical Oncologist, Fondazione IRCCS Istituto Nazionale dei Tumoridi Milano, Medical Oncology Department, Milan, Italy; 7Director of Oncology, The Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas; and 8Consultant, TUM University, Rechts der Isar, Department of Medicine III, Munich, Germany. BACKGROUND AND AIMS: Esophageal squamous cell carcinoma (ESCC) is prevalent in Asia. Since 2019, anti-programmed cell death protein-1 or programmed death-ligand 1 (anti-PD-[L]1s) have become a mainstay of ESCC treatment. However, many randomized controlled trials (RCTs) of anti-PD-(L)1s were conducted in Asian populations; thus, the applicability of these data to non-Asian cohorts is uncertain. To address this, we conducted a meta-analysis across first- (1L) and second-line (2L) RCTs in advanced/metastatic ESCC. METHODS: RCTs were identified from 2 systematic literature reviews, targeting adults receiving anti-PD-(L)1s at 1L and 2L. Three meta-analyses were performed, testing for heterogeneity and treatment effect (overall survival [OS] or progressionfree survival) in the overall population; the third examined Asian vs non-Asian subgroups. Results stability was assessed in sensitivity analyses. RESULTS: Twelve RCTs were included in the primary meta-analysis; 13 RCTs in the sensitivity analyses. Among patients with ESCC receiving 1L or 2L anti-PD-(L) 1s, OS was consistent across RCTs and there was no statistically significant difference between Asian (hazard ratio [HR], 0.70 [95% confidence interval, 0.66–0.75]) and non-Asian (HR, 0.73 [95% confidence interval, 0.63–0.85]) subgroups. For the overall population, no baseline characteristics had a significant impact on the OS HR, and neither line of therapy nor PD-(L)1 expression was shown to be a significant factor in OS heterogeneity. Progression-free survival meta-analyses were not performed due to a lack of data. CONCLUSION: This metaanalysis indicates that there is no significant difference in OS between Asian and non-Asian ESCC patients receiving 1L or 2L anti-PD-(L)1 treatment. Results may support regulatory and health technology assessment decision making. In addition, they may encourage wider guideline consideration for anti-PD-(L)1s. Keywords: Asian; Esophageal Squamous Cell Carcinoma; MetaAnalysis; Non-Asian; PD-(L)1 Inhibitors Introduction n 2022, esophageal cancer (EC) was the 11th most common cancer in terms of incidence and the sev enhalehaeding cahighesutsedisoecsaenbceurrdenath gof EloC,blyith.1 Eoavsetrern44As%af new cases arising in China alone.1,2 Esophagus tumors can have various histologies, but the 2 most prevalent areadenocarcinoma and esophageal squamous cell carcinoma (ESCC) .1 ESCC is the most common form of EC in China, accounting for over 85% of all EC cases.3 Despite advancesin ESCC diagnosis, around 60% of cases are diagnosed at an advanced/metastatic stage.4 For advanced ESCC, while surgery, radiotherapy, and/or chemotherapy still play an important role in treatment,5 targeting the programmed cell death protein-1 (PD-1) or

FAQs

What question did the meta-analysis address?

It compared the efficacy and safety evidence for anti-PD-(L)1 treatments between Asian and non-Asian patients with esophageal squamous cell carcinoma across first- and second-line randomized trials.

How were outcomes analyzed?

The analysis primarily evaluated overall survival (OS) and tested for treatment effects and heterogeneity across included trials, with stability assessed using sensitivity analyses.

What did the study find about overall survival by region?

Overall survival was consistent across trials, with no statistically significant OS difference between Asian and non-Asian subgroups receiving first- or second-line anti-PD-(L)1 therapy.

Sep 29, 2026

Uploaded by McQueen