A Bayesian Network Meta-Analysis of First-Line Treatments for Non-Small Cell Lung Cancer with High Programmed Death Ligand-1 Expression

Abstract

We performed a Bayesian network meta-analysis (NMA) to suggest frontline treatments for advanced non-small cell lung cancer (NSCLC) showing high programmed death ligand-1 (PD-L1) expression. A total of 5237 patients from 22 studies were included. In terms of progression-free survival, immune checkpoint inhibitors (ICIs) plus bevacizumab plus chemotherapy had the highest surface under the cumulative ranking curve (SUCRA) value (98.1%), followed by ICI plus chemotherapy (82.9%). In terms of overall survival (OS), dual immunotherapy plus chemotherapy had the highest SUCRA value (79.1%), followed by ICI plus bevacizumab plus chemotherapy (73.4%). However, there was no significant difference in survival outcomes among treatment regimens combined with immunotherapy. Moreover, ICI plus chemotherapy failed to reveal a significant OS superiority to ICI monotherapy (hazard ratio = 0.978, 95% credible internal: 0.771–1.259). In conclusion, this NMA indicates that ICI plus chemotherapy with/without bevacizumab might to be the best options in terms of OS for advanced NSCLC with high PD-L1 expression. However, considering that there was no significant difference in survival outcomes among treatment regimens incorporating immunotherapy and that ICI plus chemotherapy failed to show significant survival benefits over ICI monotherapy, ICI monotherapy may be reasonable as first-line treatment for advanced NSCLC with high PD-L1 expression.

First-line immunotherapy efficacy in advanced squamous non-small cell lung cancer with PD-L1 expression ≥50%: a network meta-analysis of randomized controlled trials

“…This study demonstrates that, as a first-line immunotherapy regimen, the combination of camrelizumab and chemotherapy attains optimal values for OS and PFS in patients with advanced Sq-NSCLC exhibiting programmed death-ligand 1 expression of 50% or higher. This is consistent with findings from other NMA that suggest the combination of ICIs and chemotherapy provides the most effective outcomes in the first-line treatment of advanced NSCLC patients with positive PD-L1 expression ( 40 ). Pharmacologically, chemotherapy works by directly eliminating cancer cells and inhibiting their proliferation and division, while ICIs block the interaction between PD-1 and PD-L1/PD-L2, thereby inhibiting immune escape ( 41 ).…”

Integration of artificial intelligence in lung cancer: Rise of the machine

“… 74 Several such studies have been performed in lung cancer, including evaluating safety and efficacy of bevacizumab biosimilars, 75 determining optimal platinum-based chemotherapy for early-stage resected NSCLC, 76 how smoking status influences effect of targeted therapy, 77 and choice of first-line treatment for patients on the basis of PD-L1 expression. 78 , 79 , 80 …”