Efficacy and safety of PD-1/PD-L1 inhibitors plus chemotherapy ± bevacizumab for recurrent or metastatic cervical cancer: a systematic review and meta-analysis of randomized controlled trials
- 1School of Clinical Medicine, Wuzhou Medical College
- 2The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology
- 3Guangzhou Women and Children’s Medical Center, Guangzhou Medical University
Abstract
Background: The efficacy of adding PD-1/PD-L1 inhibitors to chemotherapy ± bevacizumab in recurrent or metastatic cervical cancer is under active investigation.
Objective: To systematically evaluate the efficacy and safety of PD-1/PD-L1 inhibitors combined with chemotherapy ± bevacizumab in this setting through a meta-analysis of randomized controlled trials (RCTs).
Methods: A systematic search of PubMed, Embase, Web of Science, Cochrane Library, Scopus, and ClinicalTrials.gov was conducted for RCTs published up to January 14, 2026. Primary outcomes were overall survival (OS) and progression-free survival (PFS); hazard ratios (HRs) were derived from reconstructed Kaplan-Meier curves.
Results: Six RCTs involving 2,242 patients were included: 1,131 received PD-1/PD-L1 inhibitors plus chemotherapy ± bevacizumab, and 1,111 received chemotherapy ± bevacizumab alone. The combination regimen significantly prolonged median OS (28.7 vs. 19.4 months) and median PFS (12.0 vs. 8.7 months). Pooled risk ratios (RRs) for complete response, partial response, stable disease, progressive disease, and objective response rate were 1.606 (95% CI, 1.333–1.936), 1.127 (95% CI, 0.994–1.277), 0.733 (95% CI, 0.612–0.878), 0.460 (95% CI, 0.305–0.695), and 1.235 (95% CI, 1.153–1.322), respectively. The risk of any-grade adverse events did not differ significantly between groups (RR 0.999, 95% CI 0.991–1.008), whereas the combination was associated with an increased risk of grade ≥3 adverse events (RR 1.069, 95% CI 1.019–1.121). Frequently reported adverse reactions included nausea, anemia, constipation, arthralgia, neutropenia, hypertension, alopecia, and peripheral neuropathy.
Conclusion: In patients with recurrent or metastatic cervical cancer, the addition of PD-1/PD-L1 inhibitors to chemotherapy ± bevacizumab significantly improves OS and PFS, though with a modest increase in high-grade toxicity.
Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/ , identifier CRD420261472748
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BibTeX
@article{luo2026efficacy,
title = {{Efficacy and safety of PD-1/PD-L1 inhibitors plus chemotherapy ± bevacizumab for recurrent or metastatic cervical cancer: a systematic review and meta-analysis of randomized controlled trials}},
author = {Raoshan Luo and Minghong Li and Li Ma and Zhilong Huang},
journal = {Frontiers in Immunology},
year = {2026},
month = oct,
doi = {10.3389/fimmu.2026.1972995},
url = {https://www.frontiersin.org/articles/10.3389/fimmu.2026.1972995/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Efficacy and safety of PD-1/PD-L1 inhibitors plus chemotherapy ± bevacizumab for recurrent or metastatic cervical cancer: a systematic review and meta-analysis of randomized controlled trials
AU - Raoshan Luo
AU - Minghong Li
AU - Li Ma
AU - Zhilong Huang
PY - 2026
DA - 2026/10/19
JO - Frontiers in Immunology
DO - 10.3389/fimmu.2026.1972995
UR - https://www.frontiersin.org/articles/10.3389/fimmu.2026.1972995/full
AB - Background: The efficacy of adding PD-1/PD-L1 inhibitors to chemotherapy ± bevacizumab in recurrent or metastatic cervical cancer is under active investigation. Objective: To systematically evaluate the efficacy and safety of PD-1/PD-L1 inhibitors combined with chemotherapy ± bevacizumab in this setting through a meta-analysis of randomized controlled trials (RCTs). Methods: A systematic search of PubMed, Embase, Web of Science, Cochrane Library, Scopus, and ClinicalTrials.gov was conducted for RCTs published up to January 14, 2026. Primary outcomes were overall survival (OS) and progression-free survival (PFS); hazard ratios (HRs) were derived from reconstructed Kaplan-Meier curves. Results: Six RCTs involving 2,242 patients were included: 1,131 received PD-1/PD-L1 inhibitors plus chemotherapy ± bevacizumab, and 1,111 received chemotherapy ± bevacizumab alone. The combination regimen significantly prolonged median OS (28.7 vs. 19.4 months) and median PFS (12.0 vs. 8.7 months). Pooled risk ratios (RRs) for complete response, partial response, stable disease, progressive disease, and objective response rate were 1.606 (95% CI, 1.333–1.936), 1.127 (95% CI, 0.994–1.277), 0.733 (95% CI, 0.612–0.878), 0.460 (95% CI, 0.305–0.695), and 1.235 (95% CI, 1.153–1.322), respectively. The risk of any-grade adverse events did not differ significantly between groups (RR 0.999, 95% CI 0.991–1.008), whereas the combination was associated with an increased risk of grade ≥3 adverse events (RR 1.069, 95% CI 1.019–1.121). Frequently reported adverse reactions included nausea, anemia, constipation, arthralgia, neutropenia, hypertension, alopecia, and peripheral neuropathy. Conclusion: In patients with recurrent or metastatic cervical cancer, the addition of PD-1/PD-L1 inhibitors to chemotherapy ± bevacizumab significantly improves OS and PFS, though with a modest increase in high-grade toxicity. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/ , identifier CRD420261472748
SN - 1664-3224
ER -