barw Judi Clinical Journal 3105-4102 1 1 2025 06 29 Pembrolizumab and Sarcoma: A meta-analysis 51 62 10.70955/JCJ.2025.6 eng Rebaz M. Ali Department of Oncology, Hiwa Cancer Hospital, Sulaymaniyah, Iraq 0009-0003-7682-281X Sami S. Omar Oncology Department, Rizgary Oncology Center, Peshawa Qazi Street, Erbil, Iraq Shalaw H. Abdalla Department of Oncology, Hiwa Cancer Hospital, Sulaymaniyah, Iraq Fattah H. Fattah College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Iraq Shnya R. Hamalaw College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Iraq Hussein M. Hamasalih College of Nursing, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Iraq Ayman M. Mustafa Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq Sanaa O. Karim College of Nursing, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Iraq Yousif M. Mahmood Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq Meer M. Abdulkarim Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq Ahmed G. Hamasaeed Faculty of Medical Sciences, School of Pharmacy, University of Sulaimani, Sulaymaniyah, Iraq Dana O. Karim Department of Clinical Hematology, Hiwa Cancer Hospital, Sulaymaniyah, Iraq Abdullah D. Ahmad Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq 2025 04 02 Introduction: Pembrolizumab is a monoclonal antibody that promotes antitumor immunity. This study presents a systematic review and meta-analysis of the efficacy and safety profile of this treatment as monotherapy or in combination with other drugs for the treatment of sarcomas. Methods: A literature search was conducted across Google Scholar, PubMed/MEDLINE, and EMBASE from February 15th to April 15th. Eligible studies were clinical trials that reported efficacy or outcomes of pembrolizumab in sarcoma patients, either alone or in combination with other drugs. In contrast, those lacking sufficient data or not meeting trial criteria were excluded. Results: Ten clinical trials met the eligibility criteria, including 419 sarcoma patients (53.7% male; median age 55.4). Pembrolizumab was administered either as monotherapy in 23% of cases or in combination with other agents in 77% of cases. The progressive disease rate was 83% with monotherapy and 36% with combination therapy. Objective response rates varied, with the highest observed in the pembrolizumab plus talimogene laherparepvec combination (35%) and the lowest in pembrolizumab monotherapy (ranging from 0% to 11.2%). Median progression-free survival ranged from 1.4 (Pembrolizumab + Cyclophosphamide) to 7.8 months (Pembrolizumab + Lenvatinib in undifferentiated pleomorphic sarcoma). Combination therapy was associated with significantly better tumor response (<0.001). However, rates of endocrine, gastrointestinal, some hepatic, and dermatological adverse events were significantly associated with combination therapy compared to monotherapy (p < 0.05). Conclusion: Pembrolizumab-based combination therapies have the potential to enhance treatment efficacy in sarcoma, although they may be associated with an increased risk of adverse events.