Efficacy of immune checkpoint inhibitors combinations as first-line systemic treatment in patients with advanced urothelial carcinoma: A systematic review and network meta-analysis

Background: Combinations of immune checkpoint inhibitors (ICI) with platinum-based chemotherapy (PlatinumCT) or with another ICI in the first-line setting for patients with metastatic urothelial carcinoma (mUC) have mixed results. Methods: Records were searched electronically from January 2019 to January 2024. A meta-analysis was performed to evaluate OS, progression -free survival (PFS), and overall response rate (ORR). Results: Immune-based combinations were associated with an OS (HR: 0.75; 95% CI: 0.61 -0.92; p < 0.001; I2 = 84.1%) and PFS benefit in the intention-to-treat population (HR: 0.67; 95%CI: 0.51 -0.89; p < 0.001; I2 = 89.7%). There was no ORR improvement with immune-based combinations (HR: 1.36; 95% CI:0.84 -2.20; p < 0.001; I2 = 92.6%). Conclusion: This systematic review and study-level meta-analysis demonstrated that the immune-based combinations in first-line treatment for patients with mUC are associated with survival benefit.