Immune checkpoint inhibitors alone vs immune checkpoint inhibitors—combined chemotherapy for NSCLC patients with high PD-L1 expression: a network meta-analysis
Menée à partir d'une revue de la littérature (22 essais cliniques incluant au total 4 289 patients), cette méta-analyse en réseau évalue, du point de vue du taux de réponse objective, de la survie sans progression et de la survie globale, l'intérêt d'ajouter une chimiothérapie aux inhibiteurs de points de contrôle immunitaires pour traiter un cancer du poumon non à petites cellules exprimant fortement PD-L1
Background : We indirectly compared the effects of immune checkpoint inhibitors alone (ICI) and ICI-combined chemotherapy (chemo-ICI) in patients with non-small cell lung cancer who had high programmed death-ligand 1 (PD-L1) expression (defined as tumour proportion score ≥50% or TC3/IC3) through network meta-analyses. Methods : Through literature searches, we shortlisted 22 randomised controlled trials encompassing 4289 patients, with objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) set as the primary outcomes. The dichotomous data for ORR and hazard ratios (HRs) and their 95% confidence intervals (CIs) for OS and PFS were extracted. Results : We found that chemo-ICI had significantly improved ORR (OR 1.7, 95% CI 1.1–2.5) and PFS (HR 0.59, 95% CI: 0.48–0.74) relative to ICI. Although no significant difference in OS was observed, the analyses revealed that the chemo-ICI patients tended to undergo fewer progression events than ICI patients (HR 0.82, 95% CI 0.6–1.1). In subgroup analysis, the non-squamous, PD-1 inhibitor and first-line treatment cohorts exhibited significant differences in ORR and PFS, but not in OS. However, in the squamous, PD-L1 inhibitor, and previously treated cohorts, PFS, OS and ORR were not different between chemo-ICI and ICI patients. Conclusions : In conclusion, for non-squamous NSCLC patients, accepting PD-1 as the first-line treatment may be a relatively better option.