Page 182 - EJMO-9-2

Eurasian Journal of
Medicine and Oncology PD-1/L1 inhibitors in advanced CC: Multicenter retro

A B

Figure 3. Kaplan-Meier curves for 23 patients in the treatment group and 25 patients in the control group at stage IVB. (A) No benefit for progression-free
survival was detected in the treatment group compared to the control group (17 vs. 15 months, p=0.227). (B) No benefit for overall survival was detected
in the treatment group compared to the control group (p=0.797).

likely attributable to the limited follow-up duration in diameter derived significant survival benefits from
(p>0.05). This may be because the OS advantage tends to immunotherapy, suggesting that both molecular biomarkers
appear later due to the delayed effect of immune-mediated and anatomical tumor characteristics synergistically
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tumor control. For example, the KEYNOTE-826 trial influence therapeutic outcomes. This biomarker- and
reported a delayed OS improvement in pembrolizumab- clinical feature-driven efficacy model aligns with emerging
treated patients, with significant separation of survival paradigms in precision oncology, where multidimensional
curves after 24 months (hazard ratio = 0.64, p<0.001). stratification – incorporating immune checkpoint
expression, tumor burden metrics, and disease progression
A critical strength of this study lies in its focus on patterns – is increasingly recognized as essential for
the Chinese population, which addresses a longstanding optimizing therapeutic strategies. 22,23 Notably, analogous
gap in the evidence base. Specifically, it validates the observations in gastrointestinal malignancies further
applicability of immunotherapy in Chinese patients validate this approach. For instance, immunotherapy has
while also providing insights into potential disparities demonstrated remarkable efficacy in advanced recurrent
in treatment response between Eastern and Western or metastatic colorectal cancer (CRC), particularly when
populations. Ethnic and regional differences in tumor administered earlier in the disease course. Studies indicate
biology, genetic polymorphisms, and healthcare access that initiating ICIs before extensive chemotherapy or
may influence treatment responses. For example, Asian radiation improves PFS and OS, likely due to preserved
populations exhibit higher PD-L1 positivity rates immune function and reduced immunosuppressive
compared to Western cohorts, potentially enhancing effects of cytotoxic therapies. These findings challenge
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immunotherapy efficacy. In addition, it furnishes local traditional therapeutic sequences and advocate for front-
data to inform the refinement of biomarker screening line immunotherapy in biomarker-selected populations.
strategies. Socioeconomic disparities in China – such
as uneven HPV vaccination coverage (≤1% in rural vs. As an important biomarker for the prediction of
>70% in urban areas) and delayed diagnoses – contribute immunotherapy efficacy, PD-L1 expression level shows
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to advanced-stage presentations, necessitating tailored clear predictive value in non-small cell lung cancer and
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therapeutic strategies. These observations offer crucial melanoma, and its high expression status is significantly
3
insights for the revision of cervical cancer diagnostic correlated with the enhanced response rate to ICI
and therapeutic guidelines, as well as the development of treatment. In recent years, studies have further expanded
the biomarker spectrum. In a multicenter study, Shen
precision medicine approaches within China. Our findings et al. found that in addition to PD-L1, microsatellite
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validate that PD-1/PD-L1 inhibitors retain efficacy in real- instability (MSI) and high tumor mutation burden could
world settings despite these challenges, offering hope for be used as a combined test to predict the response to tumor
regions with limited access to clinical trial participation.
immunotherapy. Notably, in the field of CRC, Li’s et al.
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Our stratification analysis underscores the critical included a meta-analysis of 16 studies showing significant
interplay between tumor biology, clinical staging, and heterogeneity, in which the objective response rate (ORR)
treatment response in advanced cancers. Specifically, of advanced CRC patients with MSI/mismatch repair
patients with PD-L1-positive stage IIIC tumors ≤4 cm deficiency reached 37% (95% CI: 0.25 – 0.48), whereas

Volume 9 Issue 2 (2025) 174 doi:10.36922/ejmo.8074