First-Line Treatment Options for PD-L1–Negative Non-Small Cell Lung Cancer: A Bayesian Network Meta-Analysis

Frontiers in Oncology

Fei Liang¹  Song Xu²  Shao-Dong Hong³  Ling Peng⁴  De-Guang Mu⁴  Yang Xia⁵  Justin Stebbing⁶  Wen-Hua Liang⁷ 

[1] Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, China;Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China;Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China;Department of Respiratory Disease, Zhejiang Provincial People’s Hospital, Hangzhou, China;Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Key Laboratory of Respiratory Disease of Zhejiang Province, Hangzhou, China;Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, United Kingdom;National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China;

关键词: programmed death-ligand 1;    non-small cell lung cancer;    immune checkpoint inhibitor;    network meta-analysis;    immunotherapy;   

DOI  :  10.3389/fonc.2021.657545

来源: DOAJ

【 摘 要 】

BackgroundFirst-line treatment strategies for programmed death-ligand 1 (PD-L1) negative non-small cell lung cancer (NSCLC) patients include chemotherapy and combination with anti-angiogenesis drugs and/or immune checkpoint inhibitor. We conducted a Bayesian network meta-analysis to evaluate the efficacy of these therapeutic options.MethodsWe included phase III randomized controlled trials comparing two or more treatments in the first-line setting for NSCLC, including data in PD-L1–negative patients. First-line strategies were compared and ranked based on the effectiveness in terms of overall survival (OS) and progression-free survival (PFS). A rank was assigned to each treatment after Markov Chain Monte Carlo analyses.ResultsFourteen trials involving 14 regimens matched our eligibility criteria. For OS, none of the treatment were significantly more effective than chemotherapy. Nivolumab plus ipilimumab plus chemotherapy was probably the best option based on analysis of the treatment ranking (probability = 30.1%). For PFS, nivolumab plus chemotherapy plus bevacizumab, atezolizumab plus chemotherapy plus bevacizumab, and atezolizumab plus chemotherapy were statistically superior to chemotherapy in pairwise comparison. Nivolumab plus chemotherapy plus bevacizumab was likely to be the preferred option based on the analysis of the treatment ranking (probability = 72.9%).ConclusionsNivolumab plus chemotherapy, in combination with angiogenesis inhibition or anti-cytotoxic T-lymphocyte–associated antigen 4 (CTLA-4), had maximal benefits for NSCLC patient of PD-L1–negative expression. These findings may facilitate individualized treatment strategies. Safety at an individual patient level should be considered in decision making. Further validation is warranted.

【 授权许可】

Unknown