Toxicity patterns associated with chemotherapy/immune checkpoint inhibitor combinations: a meta-analysis

Aim: This study aims to clarify toxicity patterns associated with chemotherapy/immune checkpoint inhibitor combinations. Methods: Eligible studies included randomized studies evaluating chemotherapy with or without an immune checkpoint inhibitor (including pembrolizumab, nivolumab, atezolizumab, durvalumab or avelumab). The primary summary statistic was the relative risk (RR). Results: A total of 11 studies were finally included into this meta-analysis. RRs of high-grade anemia, thrombocytopenia and neutropenia were 0.98 (95% CI: 0.83-1.16; p = 0.84), 1.10 (95% CI: 0.83-1.47; p = 0.51) and 0.96 (0.78-1.17; p = 0.66), respectively. RR of high-grade nausea, vomiting and diarrhea was 1.19 (95% CI: 0.78-1.82; p = 0.42), 1.09 (95% CI: 0.69-1.72; p = 0.71) and 2.61 (1.42-4.79; p = 0.002), respectively. Conclusion: Addition of immune checkpoint inhibitors to chemotherapy backbone does not increase the risk of high-grade hematological or gastrointestinal toxicities (except for high-grade diarrhea).