The efficacy and safety of neoadjuvant chemotherapy plus immune check point inhibitors for locally advanced cervical cancer: a systematic review and meta-analysis

Immune checkpoint inhibitors (ICIs) enable organ preservation strategies and surgical de-escalation in multiple cancers.In locally advanced cervical cancer (LACC), neoadjuvant chemotherapy plus immune checkpoint inhibitors (NACI) may improve tumor response.This study conducted a systematic review and meta-analysis to evaluate the response rates and safety of NACI in LACC. We systematically searched PubMed, Web of Science, Cochrane Library, and Embase from inception to March 2025, including major congress abstracts. Phase II/III trials or retrospective analyses reporting pathological complete response (pCR), objective response rate (ORR), and adverse events (AEs) for NACI in LACC were included. Two investigators independently extracted data. Pooled rates were calculated using STATA 18.0 with random-effects models (I² statistic assessed heterogeneity). Three clinical studies involving 162 patients with locally advanced cervical cancer were included in the meta-analysis. The pooled ORR was 95.5% (95% confidence interval [CI],90.8–98.6%), while the pooled pCR rate was 45.5% (95% CI, 27.7–63.2%). Grade 3 or higher AEs occurred at a pooled rate of 35.5% (95% CI, 28.2–42.9%). Sensitivity analysis confirmed the reliability of the meta-analytic findings. The combination of chemotherapy and PD-1/PD-L1 inhibitors achieved 45.5% pCR and tolerable toxicity .The results provide theoretical basis for further studies in reducing the scope of surgery under specific conditions to minimize complicationsr surgery or preserving fertility. Neoadjuvant PD-1/PD-L1 inhibitors with chemotherapy achieved 95.5% ORR and 45.5% pCR in LACC (3 studies, n=162). Grade ≥3 AEs occurred in 35.5% of patients.