Comparative Efficacy and Safety of Immunotherapeutic Regimens with PD-1/PD-L1 Inhibitors for Previously Untreated Extensive-Stage Small Cell Lung Cancer: A Systematic Review and Network Meta-Analysis.

Koichi Ando,Tohru Ohmori,Sojiro Kusumoto,Ryo Manabe,Tsukasa Ohnishi,Hironori Sagara,Akihiko Tanaka,Toshimitsu Yamaoka,Yasunari Kishino

doi:10.3390/curroncol28020106

Koichi Ando, Tohru Ohmori + Show 7 more

Open Access

https://doi.org/10.3390/curroncol28020106

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Journal: Current Oncology	Publication Date: Feb 27, 2021
Citations: 13	License type: CC BY 4.0

Affiliation: Showa University

Abstract

Improving therapeutic strategies for extensive-stage small cell lung cancer (ES-SCLC) remains a challenge. To date, no reports have directly compared the efficacy and safety of immune checkpoint inhibitors plus platinum–etoposide (ICIs+EP) with platinum–irinotecan (IP) or directly compared different ICIs+EP for previously untreated ES-SCLC. This study used a Bayesian approach for network meta-analysis to compare efficacy and safety between ICIs+EP and IP and between each pair of three ICIs+EP. The six treatment arms were: pembrolizumab plus platinum–etoposide (Pem+EP), durvalumab plus platinum–etoposide (Dur+EP), atezolizumab plus platinum–etoposide (Atz+EP), platinum–amrubicin (AP), IP, and platinum–etoposide (EP). No significant differences in overall survival were observed between ICIs+EP and IP and between each pair of three ICIs+EP. The incidence of ≥grade 3 adverse events (G3-AEs) was significantly higher in ICIs+EP than IP, whereas no significant difference was found in G3-AEs between each pair of three ICIs+EP. The incidence of ≥grade 3 neutropenia and thrombocytopenia was significantly higher in ICIs+EP than IP, whereas the incidence of ≥grade 3 diarrhea was significantly lower in ICIs+EP than IP. These findings will help clinicians better select treatment strategies for ES-SCLC.

Highlights

Introduction iationsLung cancer is responsible for most cancer-induced mortality worldwide, with small cell lung cancer (SCLC) accounting for 15% of newly diagnosed lung cancer cases [1,2,3].The prognosis is unfavorable for extensive-stage SCLC (ES-SCLC), which accounts for80% to 85% of newly diagnosed SCLC, with a reported median survival time of 7 to 10 months and a 5-year survival rate of not more than 8%, despite a systemic cancer treatment response rate of more than 50% [1,2,3,4,5]
The results revealed no significant difference in G3-diarrhea between the immune checkpoint inhibitors plus platinum–etoposide (ICIs+EP) group and EP group and between the immune checkpoint inhibitors (ICIs)+EP and AP groups, with risk ratio (RR) (95% credible interval (CrI)) of 1.345 (0.525–2.840) and 0.842 (0.130–2.899), respectively, whereas G3-diarrhea was significantly lower in the ICIs+EP group than IP group, with an RR (95% CrI) of 0.156 (0.049–0.378) (Figure 8)
The results revealed that the incidence of G3-NP or TP was significantly higher in ICIs+EP, in atezolizumab plus platinum–etoposide (Atz+EP), or in Pem+EP than that in IP, whereas the incidence of G3-diarrhea was significantly lower in ICIs+EP, in Pem+EP, or in durvalumab plus platinum–etoposide (Dur+EP)

Summary

Introduction

Lung cancer is responsible for most cancer-induced mortality worldwide, with small cell lung cancer (SCLC) accounting for 15% of newly diagnosed lung cancer cases [1,2,3]. 80% to 85% of newly diagnosed SCLC, with a reported median survival time of 7 to 10 months and a 5-year survival rate of not more than 8%, despite a systemic cancer treatment response rate of more than 50% [1,2,3,4,5]. The efficacy of immune checkpoint inhibitors (ICIs) such as Programmed Cell. Death-1 (PD-1)/Programmed Death-Ligand 1 (PD-L1) inhibitors (pembrolizumab (Pem), durvalumab (Dur), or atezolizumab (Atz)) plus platinum–etoposide (EP) for previously untreated ES-SCLC has been reported [6,7,8]. Compared with EP treatment alone, Pem+EP, Licensee MDPI, Basel, Switzerland.

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