TY - JOUR
T1 - Comparative efficacy of chemoimmunotherapy versus immunotherapy for advanced non–small cell lung cancer
T2 - A network meta-analysis of randomized trials
AU - Pathak, Ranjan
AU - De Lima Lopes, Gilberto
AU - Yu, Han
AU - Aryal, Madan Raj
AU - Ji, Wenyan
AU - Frumento, Katherine Stemmer
AU - Wallis, Christopher J.D.
AU - Klaassen, Zachary
AU - Park, Henry S.
AU - Goldberg, Sarah B.
N1 - Publisher Copyright:
© 2020 American Cancer Society
PY - 2021/3/1
Y1 - 2021/3/1
N2 - Background: To the authors' knowledge, in the absence of head-to-head trials, it is unclear whether chemoimmunotherapy provides an additional overall survival (OS) benefit compared with immunotherapy alone in the first-line treatment of patients with advanced non–small cell lung cancer (NSCLC). The authors conducted a systematic literature review and network meta-analysis (NMA) to compare the efficacy of chemoimmunotherapy versus ICI. Methods: MEDLINE, Excerpta Medica dataBASE (EMBASE), Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched from inception to April 2020. Phase 3 trials evaluating the efficacy of first-line ICI or chemoimmunotherapy and reporting efficacy outcomes (OS, progression-free survival [PFS], and the overall response rate [ORR]) stratified by programmed death–ligand 1 (PD-L1) status were included. NMA with a Bayesian random effects model was performed. Results: A total of 12 eligible trials comprising 7845 patients were included. In patients who were negative for PD-L1 (tumor proportion score [TPS] <1%), NMA comparing chemoimmunotherapy with dual-agent ICI failed to demonstrate a statistically significant difference with regard to OS, PFS, or the ORR. In patients with low PD-L1 (TPS 1%-49%), there was no statistically significant difference observed between chemoimmunotherapy compared with either single-agent ICI or dual-agent ICI with regard to OS or the ORR. In patients with high PD-L1 (TPS ≥50%), chemoimmunotherapy was found to be associated with an improved PFS and ORR compared with single-agent ICI, but not with dual-agent ICI. No differences in OS were observed with chemoimmunotherapy when compared with either single-agent or dual-agent ICIs. Conclusions: Although chemoimmunotherapy appears to improve the ORR and PFS in patients with PD-L1–high tumors when compared with single-agent ICI, it does not appear to confer an OS benefit over single-agent or dual-agent ICI for patients with advanced NSCLC regardless of PD-L1 status. Prospective trials are needed to validate these findings.
AB - Background: To the authors' knowledge, in the absence of head-to-head trials, it is unclear whether chemoimmunotherapy provides an additional overall survival (OS) benefit compared with immunotherapy alone in the first-line treatment of patients with advanced non–small cell lung cancer (NSCLC). The authors conducted a systematic literature review and network meta-analysis (NMA) to compare the efficacy of chemoimmunotherapy versus ICI. Methods: MEDLINE, Excerpta Medica dataBASE (EMBASE), Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched from inception to April 2020. Phase 3 trials evaluating the efficacy of first-line ICI or chemoimmunotherapy and reporting efficacy outcomes (OS, progression-free survival [PFS], and the overall response rate [ORR]) stratified by programmed death–ligand 1 (PD-L1) status were included. NMA with a Bayesian random effects model was performed. Results: A total of 12 eligible trials comprising 7845 patients were included. In patients who were negative for PD-L1 (tumor proportion score [TPS] <1%), NMA comparing chemoimmunotherapy with dual-agent ICI failed to demonstrate a statistically significant difference with regard to OS, PFS, or the ORR. In patients with low PD-L1 (TPS 1%-49%), there was no statistically significant difference observed between chemoimmunotherapy compared with either single-agent ICI or dual-agent ICI with regard to OS or the ORR. In patients with high PD-L1 (TPS ≥50%), chemoimmunotherapy was found to be associated with an improved PFS and ORR compared with single-agent ICI, but not with dual-agent ICI. No differences in OS were observed with chemoimmunotherapy when compared with either single-agent or dual-agent ICIs. Conclusions: Although chemoimmunotherapy appears to improve the ORR and PFS in patients with PD-L1–high tumors when compared with single-agent ICI, it does not appear to confer an OS benefit over single-agent or dual-agent ICI for patients with advanced NSCLC regardless of PD-L1 status. Prospective trials are needed to validate these findings.
KW - combination
KW - drug therapy
KW - immunotherapy
KW - meta-analysis
KW - network
KW - non–small cell lung carcinoma
KW - programmed cell death protein 1 receptor/antagonists and inhibitors
KW - survival analysis
KW - systematic review
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U2 - 10.1002/cncr.33269
DO - 10.1002/cncr.33269
M3 - Article
C2 - 33119177
AN - SCOPUS:85094217062
SN - 0008-543X
VL - 127
SP - 709
EP - 719
JO - Cancer
JF - Cancer
IS - 5
ER -