Comparative Effectiveness of Atezolizumab, Nivolumab, and Docetaxel in Patients With Previously Treated Non–Small Cell Lung Cancer

Abstract

IMPORTANCEEvidence regarding real-world effectiveness of therapies for patients with advanced non-small cell lung cancer (NSCLC) whose tumors are resistant to platinum-based chemotherapy is lacking. OBJECTIVE To compare the effectiveness of the immune checkpoint inhibitors atezolizumab (programmed cell death ligand 1 inhibitor) and nivolumab (programmed cell death 1 inhibitor) and the chemotherapy drug docetaxel in patients with advanced NSCLC resistant to platinum-based chemotherapy. DESIGN, SETTING, AND PARTICIPANTSThis comparative effectiveness study compared patients aged 18 years or older with advanced NSCLC who initiated atezolizumab, docetaxel, or nivolumab and who had previously been exposed to platinum-based chemotherapy using nationally representative real-world data from more than 280 US cancer clinics. Patients were followed-up

Real-World Analysis of Nivolumab and Atezolizumab Efficacy in Previously Treated Patients with Advanced Non-Small Cell Lung Cancer

“…Atezolizumab and nivolumab, PD-L1 and PD-1 antibodies, respectively, are proven to be effective and safe in clinical trials [ 3 , 4 , 6 ] and after approval by authorities in real-world studies ( Table 1 ) [ 9 , 10 , 12 , 13 , 14 , 15 , 16 , 17 ]. However, there is no head-to-head clinical trial that compares the results of each drug, and to our knowledge, there are only two real-world studies that have compared outcomes between the two ICIs [ 11 , 12 ]. However, they did not perform a head-to-head subgroup analysis between the two ICIs.…”

“…Concerning the real world, Mencoboni et al [ 8 ] performed a meta-analysis that enrolled 32 studies, most of which were treated with nivolumab, concluding that the efficacy and safety of ICIs in clinical practice are comparable to those in clinical trials. Recently, Ramagopalan et al [ 11 ], in a real-world study of a large cohort (3336 patients), did not find significant differences in OS between atezolizumab and nivolumab in the overall population or in any subgroup that was examined. Similar results were reported by Weis et al [ 12 ] in a smaller cohort.…”

“…To our knowledge, only two studies compared them. Ramagopalan et al [ 11 ] studied them in a large cohort that compared the effectiveness (OS), and Weis et al [ 12 ] compared survival, response and toxicity, concluding in both cases that there was no statistically significant difference between the two treatments. With this aim, the main objective of this work is to characterize and compare the results (survival, response and safety) between nivolumab and atezolizumab in pretreated (second- and third-line treatment) patients with advanced NSCLC.…”

Association Between Smoking History and Overall Survival in Patients Receiving Pembrolizumab for First-Line Treatment of Advanced Non–Small Cell Lung Cancer

“…Multiple imputation using chained equations and delta-based tipping point analysis were used for sensitivity analyses of missing data assumptions as described previously. 12 Statistical analyses were performed using the R programming environment (version 3.6.3). Details are in the eMethods in the Supplement .…”

Transportability of Overall Survival Estimates From US to Canadian Patients With Advanced Non–Small Cell Lung Cancer With Implications for Regulatory and Health Technology Assessment

“…Because second-line PD-L1 immunotherapy has been associated with significant improvement in OS compared with second-line docetaxel in patients who experienced disease progression while receiving first-line chemotherapy, [18][19][20] we quantified the consequences of differences in the JAMA Network Open | Statistics and Research Methods prevalence of second-line immunotherapy between the US and Canada for OS in the first-line chemotherapy cohort. The US-standardized risks for the first-line chemotherapy cohort under these hypothetical treatment regimens are shown in Figure 3.…”