Abstract
BackgroundThis meta‐analysis systematically evaluated the efficacy of PD‐1 and PD‐L1 inhibitors for the treatment of advanced non‐small cell lung cancer (NSCLC) and investigated the efficacy of first‐line therapy and PD‐1 versus PD‐L1 inhibitors.MethodsPubMed, The Cochrane Library, and Embase were searched up to November 2018 for randomized controlled trials (RCTs) for eligible studies. The outcome of interest was overall survival (OS). The methodology was based on the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses and Cochrane Collaboration guidelines. Data were pooled by using the random effects model and expressed as hazard ratios (HRs) and corresponding 95% confidence intervals (CIs). Heterogeneity was assessed and quantified (I 2).ResultsSeven RCTs were included in this study. PD‐1/PD‐L1 inhibitors achieved superior OS compared to chemotherapy (HR 0.72, 95% CI 0.63–0.82; P < 0.0001). OS was superior in previously treated patients compared to untreated patients (HR 0.69, 95% CI 0.63–0.76; HR 0.82, 95% CI 0.47–1.44, respectively). No significant differences in OS were observed between PD‐1 and PD‐L1 inhibitors (HR 0.71, 95% CI 0.59–0.86; HR 0.73, 95% CI 0.63–0.84, respectively).ConclusionsPD‐1/PD‐L1 inhibitors significantly prolonged the OS of previously treated patients. No significant differences in OS were observed between PD‐1 and PD‐L1 inhibitors.
Highlights
Immunotherapy is a new therapeutic option for multiple tumor types, including non-small cell lung cancer (NSCLC)
This trial showed that overall survival (OS) in patients treated with nivolumab and chemotherapy was similar.[2]
In an analysis of available phase I–III studies, Khunger et al revealed a high objective response rates (ORRs) and higher rate of immunemediated pneumonitis in patients with previously untreated NSCLC compared to patients administered chemotherapy
Summary
Immunotherapy is a new therapeutic option for multiple tumor types, including non-small cell lung cancer (NSCLC). PD-1 and PD-L1 inhibitors that target the PD-1 and PD-L1 pathways have demonstrated clinical efficacy and safety for the treatment of NSCLC.[1,2,3,4,5,6,7] The United States Food and Drug Administration (FDA) has approved pembrolizumab for the first-line treatment of metastatic NSCLC patients with high tumor PD-L1 expression.[8,9] according to the results of the CheckMate 026 trial, nivolumab did not result in significantly longer progression-free survival compared to systemic chemotherapy in patients with previously untreated stage IV or recurrent NSCLC with a PD-L1 expression level of ≥ 5% This trial showed that overall survival (OS) in patients treated with nivolumab and chemotherapy was similar.[2] Atezolizumab and durvalumab are human-engineered immunoglobulin G1 (IgG1) monoclonal antibodies targeting PD-L1 and have a mechanism of action distinct from anti-PD-1 antibodies. No significant differences in OS were observed between PD-1 and PD-L1 inhibitors
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