患有晚期实体瘤的患者的结果，这些抑制剂中断：系统评价和荟萃分析

探索了不连续的免疫检查点抑制剂（ICIS）的转移性肿瘤患者的结果不为性疾病（PD）。我们对所有研究报告的临床结果进行了荟萃分析，这些研究因PD以外的其他原因而停止ICI的患者的临床结果。我们搜索了从每个数据库的成立到2023年12月的PubMed，embase和Scopus数据库，到2023年12月，进行临床试验（随机化与否），并评估了PD-（L）和CTLA-4的观察性研究。除了PD以外的其他原因治疗。每项研究都必须提供游泳者地块或Kaplan-Meier生存曲线，以便在中止免疫疗法后重建有关无进展生存（PFS）的单个患者级别数据。主要终点是从总体上停用的日期和根据肿瘤组织型，治疗类型和停用原因的PFS。该方法用于估计假设在研究水平上随机效应的荟萃分析非参数摘要生存曲线。包括三十六个研究（2180名患者）。合并的中位PFS（MPFS）为24.7个月（95％CI，18.8-30.6），PFS速率分别为12、24和36个月，为69.8％（95％CI，63.1-77.3），51.0％，51.0％（95％CI，43.4-59.4-59.8）和95％（95％CI，95％）（95％）（95％）（95％）（95％），95％（95％）。单变量分析表明，与非小细胞肺癌（NSCLC，13.5个月）和肾细胞癌相比，黑色素瘤患者（43.0个月）的MPF明显更长，而MPF则更长。与抗PD-（L）1+抗CTLA-4治疗的患者相比，与抗PD-（L）1单一疗法相比（44.6 ves 19.9个月； P值<0.001），而在NSCLC中，与毒性发作相比，当治疗原因是当前的治疗原因时（19.6 vors 4.8个月4.8个月）；多变量分析证实了这些差异。由于黑色素瘤患者的临床病理学特征而导致ICI的长期结局基本上受到临床病理学特征的影响：黑色素瘤患者的PF较长，并且/或接受抗PD-（l）1+抗CTLA-4的治疗方法的患者和/或在RCC患者中使用RCC的患者，并在患者中进行治疗。大学与研究部（PRIN 2022Y7HHNW）。

The outcome of patients with metastatic tumors who discontinued immune checkpoint inhibitors (ICIs) not for progressive disease (PD) has been poorly explored. We performed a meta-analysis of all studies reporting the clinical outcome of patients who discontinued ICIs for reasons other than PD.We searched PubMed, Embase and Scopus databases, from the inception of each database to December 2023, for clinical trials (randomized or not) and observational studies assessing PD-(L)1 and CTLA-4 inhibitors in patients with metastatic solid tumors who discontinued treatment for reasons other than PD. Each study had to provide swimmer plots or Kaplan-Meier survival curves enabling the reconstruction of individual patient-level data on progression-free survival (PFS) following the discontinuation of immunotherapy. The primary endpoint was PFS from the date of treatment discontinuation overall and according to tumor histotype, type of treatment and reason of discontinuation. The Combersure's method was used to estimate meta-analytical non-parametric summary survival curves assuming random effects at study level.Thirty-six studies (2180 patients) were included. The pooled median PFS (mPFS) was 24.7 months (95% CI, 18.8-30.6) and the PFS-rate at 12, 24, and 36 months was respectively 69.8% (95% CI, 63.1-77.3), 51.0% (95% CI, 43.4-59.8) and 34.0% (95% CI, 27.0-42.9). Univariable analysis showed that the mPFS was significantly longer for patients with melanoma (43.0 months), as compared with non-small cell lung cancer (NSCLC, 13.5 months) and renal cell carcinoma (RCC, 10.0 months; between-strata comparison test p-value < 0.001); for patients treated with anti-PD-(L)1 + anti-CTLA-4 as compared with anti-PD-(L)1 monotherapy (44.6 versus 19.9 months; p-value < 0.001), and in NSCLC when the reason of treatment discontinuation was elective as compared with toxicity onset (19.6 versus 4.8 months; p-value = 0.003). The multivariable analysis confirmed these differences.The long-term outcome of patients who stopped ICIs for reasons other than PD was substantially affected by clinicopathological features: PFS after treatment discontinuation was longer in patients with melanoma, and/or treated with anti-PD-(L)1 + anti-CTLA-4, and shorter in patients with RCC or in those patients with NSCLC who stopped treatment for toxicity onset.The Italian Ministry of University and Research (PRIN 2022Y7HHNW).