Efficacy and safety of immune checkpoint inhibitors combined with anti‑angiogenic agents for advanced cervical cancer: A systematic review and meta‑analysis

Combining anti‑angiogenic agents with immune checkpoint inhibitors (ICIs) may improve clinical outcomes in patients with advanced cervical cancer. However, the majority of available evidence is derived from small‑sample single‑arm trials. The present systematic review and meta‑analysis aimed to evaluate the efficacy and safety of this combination regimen in patients with advanced cervical cancer. A systematic search was conducted across eight major databases, including PubMed, the Cochrane Library, Embase, Web of Science, Chinese National Knowledge Infrastructure, Chinese Biological Medicine Database, Wanfang Data and VIP Database, with a retrieval cutoff date of April 14, 2026. Sensitivity analysis and heterogeneity testing were subsequently performed. A total of five clinical trials encompassing 336 patients fulfilled the predefined inclusion criteria. Pooled analyses were conducted for several endpoints, namely objective response rate (ORR), disease control rate (DCR), median progression‑free survival (PFS), overall survival (OS), 1‑year overall survival rate (1‑y OSR) and the incidence of adverse events (AEs). A total of five independent trial cohorts comprising 336 patients were ultimately included in the pooled analysis. The synthetic results revealed a pooled ORR of 37% and a DCR of 80%. The pooled PFS and OS were 8.05 months and 20.24 months, respectively, with a pooled 1‑y OSR of 62%. For grade 1‑2 AEs, the most common were proteinuria (42%), increased aspartate aminotransferase (38%), increased alanine aminotransferase (33%), diarrhea (30%) and decreased platelet count (30%). Only two grade ≥3 AEs had an incidence >10%, while all others had an incidence <3%. These two events were anemia and hypertension with incidences of 14 and 13%, respectively. Treatment‑related mortalities were reported in two trials, involving a total of five cases. The present meta‑analysis indicates that combination therapy with anti‑angiogenic agents and ICIs confers potential survival benefits alongside a tolerable and manageable safety profile for patients with advanced cervical cancer. Nonetheless, these findings should be interpreted with caution, due to the limited number of included studies and the occurrence of treatment‑related mortalities.