Anti-PD-1/anti-PD-L1 immunotherapy versus docetaxel for previously treated advanced non-small cell lung cancer: a systematic review and meta-analysis of randomised clinical trials

Abstract

BackgroundTo compare the efficacy and toxicity of anti-programmed cell death receptor 1 (PD-1) and anti-programmed cell death ligand 1 (PD-L1) versus docetaxel in previously treated patients with advanced non-small cell lung cancer (NSCLC).Materials and methodsPhase III randomised clinical trials (RCTs) were identified after systematic review of databases and conference proceedings. A random-effect model was used to determine the pooled HR for overall survival (OS), progression-free survival (PFS) and duration of response. The pooled OR for overall response and treatment-related side effects were calculated using the inverse-variance method. Heterogeneity was measured using the τ2 and I2 statistics.ResultsAfter the systematic review, we included four phase III RCTs (n=2737) in this meta-analysis. The use of anti-PD-1/anti-PD-L1 agents (atezolizumab, nivolumab and pembrolizumab) was associated with better OS in comparison with docetaxel alone (HR: 0.69; 95% CI 0.63 to 0.75; p<0.00001). Similarly, the PFS and duration of response was significantly longer for patients receiving immunotherapy (HR: 0.85; 95% CI 0.75 to 0.96; p=0.007 and HR:0.32; 95% CI 0.24 to 0.43; p<0.00001, respectively) versus single agent chemotherapy. The overall response rate was also higher for patients who received any anti-PD-1/anti-PD-L1 therapy in comparison with docetaxel (OR: 1.77; 95% CI 1.26 to 2.50; p=0.001). Regarding treatment-related side effects grade 3 or higher, patients who received immunotherapy experienced less events than patients allocated to docetaxel (OR: 0.19; 95% CI 0.12 to 0.30; p<0.00001)ConclusionThe use of anti-PD-1/anti-PD-L1 therapy in patients with progressive advanced NSCLC is significantly better than the use of docetaxel in terms of OS, PFS, duration of response and overall response rate.

PD-1/PD-L1 Blockade Therapy in Advanced Non-Small-Cell Lung Cancer: Current Status and Future Directions

“…Collectively, these results demonstrate that ICIs targeting PD‐1 and PD‐L1 significantly improve clinical efficacy in patients with advanced NSCLC with a favorable safety profile compared with chemotherapy , making anti‐PD‐1 and PD‐L1 therapeutic antibodies a new option as second‐line treatment in patients with advanced NSCLC.…”

“…For instance, Chinese patients with NSCLC have high EGFR mutation rates (50% in the Chinese population vs. 20% in Western populations) . EGFR mutations were previously considered to be associated with low response rates in anti‐PD‐1/PD‐L1 treatments . The Chinese population also harbors different microbiota and microbiomes , as well as different biochemical and metabolic profiles , which may affect the efficacy of ICI treatments and biomarker profiles for the prediction and prognosis of the diseases.…”

The efficiency of 18F-FDG PET-CT for predicting the major pathologic response to the neoadjuvant PD-1 blockade in resectable non-small cell lung cancer

“…Immunotherapy is one of the most exciting fields in NSCLC with the potential for prolonged benefits [3]. Evaluation of this novel therapy is a major challenge, since immunotherapy radically differs from other strategies in relying on the reactivation of the immune system to recognize and kill cancer cells [21].…”

“…Worldwide, non-small cell lung cancer (NSCLC) is the most common cause of cancer death [1,2], and more than 70% of patients are found as locally advanced or metastatic disease at the time of diagnosis. Immunotherapy has become a new therapeutic approach in NSCLC with the potential for prolonged benefits [3]. Since 2015, three immune checkpoint inhibitors (nivolumab, pembrolizumab, and atezolizumab) have been approved by the US Food and Drug Administration (FDA) for the treatment of NSCLC [4].…”

How I treat cancer special issue

“…These patient-oriented publications were complemented by aspects concerning the oncological profession 4 43. Further, a more profound understanding of challenging side effects was addressed in several articles 44–50. Thus, ESMO Open – Cancer Horizons has established itself as a reliable source of information on the very many aspects of cancer and cancer care published within it.…”