Abstract
Immunotherapy is a novel treatment for advanced non-small cell lung cancer (NSCLC) patients. Immunotherapy includes two main broad classes of therapeutic vaccines and immune checkpoint inhibitors, as well as cytokines, biological response modifiers and cellular therapy. The present systematic review and meta-analysis aims to evaluate the efficacy and safety of different classes of immunotherapy in patients with advanced NSCLC. Literature search was done on Medline, Embase and Cochrane Library. The primary endpoints were overall survival (OS) and grade ≥3 adverse events. Twenty randomized controlled trials were finally identified in our study. Efficacy analysis indicated an improvement of OS in advanced NSCLC patients after treating by therapeutic vaccines and immune checkpoint inhibitors, but not for other immunomodulators. Safety analysis showed that immunotherapy was well-tolerated. All kinds of grade ≥3 adverse events were similar between experimental group and control group except that neutropenia and thrombocytopenia had a higher incidence in patients received vaccines. In conclusion, immunotherapy is a promising treatment for advanced NSCLC patients. Our findings will be further confirmed and supplemented by several phase II and phase III RCTs which are going to complete in near future.
Highlights
Overall survival in the treatment group compared to placebo group for patients with advanced Non-small cell lung cancer (NSCLC) in the phase III FORTIS-M trial[20,21,22]
We initially identified a total of 547 papers from database search and 1054 American Society of Clinical Oncology (ASCO) abstracts. 170 papers were excluded due to duplication. 89 papers and 43 ASCO abstracts fulfilled our inclusion criteria after reading the titles and abstracts
Information of 43 ASCO abstracts were collected by their clinical trial numbers through Clinicaltrials.gov or Google Scholar
Summary
Overall survival in the treatment group compared to placebo group for patients with advanced NSCLC in the phase III FORTIS-M trial[20,21,22]. Meta-analysis is an approach to assess the overall efficacy and safety of immunotherapy by pooling patient samples. The study may not be accurate in classifying immunotherapy treatments. They included 3 trials of cetuximab and 1 trial of trastuzumab as monoclonal antibodies subgroup, which should be classified as target therapy as their targets (EGFR and HER-2 respectively) were related to the growth of tumors’ blood vessels instead of human’s immune system. Our systematic review and meta-analysis aims to provide more reliable and up-to-date evidence on the efficacy and safety of immunotherapy for advanced NSCLC patients
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