The optimal immune checkpoint inhibitors combined with chemotherapy for advanced non‑small‑cell lung cancer:: a systematic review and meta‑analysis

• Y. Yang ^[1] ; H. Luo ^[1] ; X. L. Zheng ^[1] ; H. Ge ^[1]
  1. [1] Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Dong Ming Road 127#, Zhengzhou 450008, China
• Localización: Clinical & translational oncology, ISSN 1699-048X, Vol. 23, Nº. 6, 2021, págs. 1117-1127
• Idioma: inglés
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• Resumen

  • BackgroundImmune checkpoint inhibitors (ICIs) plus chemotherapy (CT) have strikingly expanded the therapeutic land-scape for advanced non-small cell lung cancer (NSCLC), but little is known about which is superior. We performed a meta-analysis that compared the efficacy and safety of PD-1 inhibitor + CT with PD-L1 inhibitor + CT.MethodsPubMed, Embase, Web of Science, Cochrane Library, and major international scientific meetings were searched for relevant randomized controlled trials (RCTs), and the indirect analysis was performed for PD-1 + CT vs PD-L1 + CT. The outcomes included progression-free survival (PFS), overall survival (OS), objective response rate (ORR) and treatment-related adverse events (TRAEs).Results8 phase III RCTs with 4253 patients comparing PD-1/PD-L1 + CT in NSCLC were included. The PD-1 + CT led to notably longer OS most in low/negative expression of PD-L1 for NSCLC patients compared with PD-L1 + CT. In terms of Grade 3–5 TRAEs, the results showed that PD-1 + CT and PD-L1 + CT exclusively increased the risk of adverse incidence than CT alone, especially for PD-L1 + CT (p < 0.00001). For subgroups including female, young patients, patients with non-smoker, and EGFR/ALK wild-type, PD-1 + CT was associated with prolonged OS (p < 0.05). Meanwhile, for no liver metas-tasis of NSCLC patients, we found obviously OS advantage for patients treated with PD-1 + CT compared to PD-L1 + CT.ConclusionsICIs + CT seemed to be more effective first-line regimen and PD-1 + CT could be recommended as the first-rank therapy for advanced NSCLC patients with low/negative expression of PD-L1. However, we should be particularly vigilant about the occurrence of the Grade 3–5 TRAEs.