PD-(L)1 Inhibitors as Monotherapy for the First-Line Treatment of Non-Small-Cell Lung Cancer Patients with High PD-L1 Expression: A Network Meta-Analysis.
Margarita Majem TarruellaManuel CoboDolores IslaDiego Marquez-MedinaDelvys Rodriguez-AbreuJoaquín Casal-RubioTeresa Moran BuenoReyes Bernabé-CaroDiego Pérez ParentePedro Ruiz-GraciaMarta Marina ArroyoLuis Paz-AresPublished in: Journal of clinical medicine (2021)
Programmed cell death-ligand 1 (PD-L1) has emerged as a potential biomarker for selection of patients more likely to respond to immunotherapy and as a prognostic factor in non-small cell lung cancer (NSCLC). In this network meta-analysis, we aimed to evaluate the efficacy of first-line anti-PD-(L)1 monotherapy in advanced NSCLC patients with high PD-L1 expression (≥50%) compared to platinum-based chemotherapy. We also evaluated efficacy outcomes according to tumor mutational burden (TMB). To that end, we conducted a systematic review. Six clinical trials with 2111 patients were included. In head-to-head comparisons, immunotherapy showed a significant improvement in progression-free survival (PFS: HRpooled = 0.69, 95% CI: 0.52-0.90, p = 0.007), overall survival (OS: HRpooled = 0.69, 95% CI: 0.61-0.78; p < 0.001) and overall response rate (ORR) (Risk ratio (RR)pooled = 1.354, 95% CI: 1.04-1.762, p = 0.024). In the assessment of relative efficacy for PFS through indirect comparisons, pembrolizumab (results from KEYNOTE-024) ranked highest followed by cemiplimab and atezolizumab, with statistical significance determined for some of the drugs. In terms of OS, cemiplimab ranked highest followed by atezolizumab and pembrolizumab, although non-significant OS was determined for these drugs. In conclusion, PD-(L)1 inhibitor monotherapy improves efficacy outcomes in the first line setting of advanced NSCLC patients with high PD-L1 expression. Evaluations with longer follow up are still needed to determine the superiority of any specific drug.
Keyphrases
- prognostic factors
- end stage renal disease
- small cell lung cancer
- clinical trial
- advanced non small cell lung cancer
- systematic review
- free survival
- ejection fraction
- chronic kidney disease
- newly diagnosed
- open label
- peritoneal dialysis
- randomized controlled trial
- emergency department
- type diabetes
- weight loss
- locally advanced
- epidermal growth factor receptor
- brain metastases
- phase ii
- insulin resistance
- rectal cancer
- case control
- meta analyses