Comparative efficacy of chemoimmunotherapy versus immunotherapy for advanced non–small cell lung cancer: A network meta‐analysis of randomized trials

Abstract

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.

Clinical features and prognostic factors of combined small cell lung cancer: development and validation of a nomogram based on the SEER database

“…However, the effect of radiation therapy on CSCLC patients remains unknown (4). In the recent years, new treatment strategies, including targeted therapies, checkpoint blockade immunotherapies, and combined treatments have largely improved the outcome of both SCLC and NSCLC (23,24). Gene mutation and transcriptional regulators in CSCLC has been gained in recent years (8,(25)(26)(27).…”

Cost-Effectiveness of Pembrolizumab Plus Chemotherapy Versus Pembrolizumab Monotherapy in Metastatic Non-Squamous and Squamous NSCLC Patients With PD-L1 Expression ≥ 50%

“…In the second scenario analysis, when we combined an age-matched background mortality rate with the clinical data of fatal treatment-related AEs to calculate the transition probabilities for death, the results showed that first-line Pembro+Chemo gained lower QALYs than first-line Pembro. However, first-line Pembro+Chemo is generally known to be superior to first-line Pembro in survival ( Di Federico et al, 2021 ; Pathak et al, 2021 ), so this result is likely to be untenable. Therefore, background mortality rate application technology should be used with caution because it lacks the ability to directly map clinical effects of treatments.…”

“…Immune-checkpoint inhibitors (ICIs), either as a monotherapy or in combination with chemotherapies, have become the backbone of the standard of care for this disease ( National Comprehensive Cancer Network, 2021 ). Tumor cell programmed death-ligand 1 (PD-L1), as the most robust predictor of the clinical response to ICIs, is recommended to be tested to guide the selection of treatment strategies for metastatic driver-negative NSCLC ( Di Federico et al, 2021 ; Grant et al, 2021 ; Pathak et al, 2021 ). The latest National Comprehensive Cancer Network (NCCN) guidelines for NSCLC recommend replacing traditional chemotherapies with ICIs-containing regimens as the preferred first-line therapies for NSCLC when PD-L1 expresses in at least 50% of tumor cells ( National Comprehensive Cancer Network, 2021 ).…”

FP10.01 The Efficacy of Immunotherapy in non-Small Cell Lung Cancer Patients with Uncommon Mutations: a Real World Research from Single Site

“…A recent network metaanalysis has suggested that combination chemo-immunotherapy does not confer a survival benefit over single or combination checkpoint inhibitor therapy. 21 This is being tested in the Eastern Cooperative Oncology Group 5163 trial, comparing first-line immunotherapy followed by sequential (or additional) chemotherapy upon disease progression with first-line combination chemotherapy plus immunotherapy in patients with advanced, PD-L1-expressing, non-squamous NSCLC (NCT03793179).…”