BACKGROUND:Esophageal cancer (EC) remains a highly aggressive malignancy with a poor prognosis despite advancements in treatment. Toripalimab, a PD-1 inhibitor, has demonstrated the potential to improve clinical outcomes. This systematic review and meta-analysis assess the efficacy and safety of Toripalimab in EC.
METHODS:Following PRISMA 2020 guidelines, we conducted a systematic review and meta-analysis, searching PubMed, Embase, Scopus, ScienceDirect, and Google Scholar up to January 2025. Eligible studies evaluated Toripalimab in esophageal cancer, including randomized controlled trials and non-randomized controlled trials. Primary outcomes included overall survival (OS), progression-free survival (PFS), and objective response rate (ORR), while safety outcomes assessed treatment-related adverse events. Data were synthesized using random-effects models, with heterogeneity evaluated via Cochrane's Q and I2 statistics.
RESULTS:The pooled analysis included six studies involving 678 patients. Toripalimab demonstrated promising efficacy, with a Complete Response (CR) rate of 33%, Partial Response (PR) rate of 36%, pathological complete response (pCR) rate of 30%, and major pathological response (MPR) rate of 46%. The R0 resection rate was 87%, while OS and PFS rates were reported at 78% and 50%, respectively. Anemia (56%), alopecia (54%), leukopenia (54%), and fatigue (30%) were the most frequently reported adverse effects. Other common adverse effects included nausea (29%), constipation (18%), and vomiting (20%).
CONCLUSIONS:Toripalimab demonstrates significant potential in treating esophageal cancer, with favorable response rates and survival outcomes. However, the high incidence of adverse effects highlights the need for supportive care and ongoing research. While based on limited sample sizes and single-arm studies that may introduce bias and affect generalizability in this review, we provide valuable preliminary insights into toripalimab's potential, highlighting the need for larger randomized trials to build on these findings.