Efficacy and safety of first-line checkpoint inhibitors-based treatments for non-oncogene-addicted non-small-cell lung cancer: a systematic review and meta-analysis

ESMO Open

article

M.A. Siciliano¹  G. Carid๠ D. Ciliberto²  M. d’Apolito¹  C. Pelaia¹  D. Caracciolo¹  C. Riillo¹  P. Correale³  A. Galvano⁴  A. Russo⁴  V. Barbieri⁵  P. Tassone¹  P. Tagliaferri¹ 

[1] Department of Experimental and Clinical Medicine, Magna Græcia University;Mater Domini University Hospital;Unit of Medical Oncology, Oncology Department, Grand Metropolitan Hospital ‘Bianchi Melacrino-Morelli’, Reggio Calabria;Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, Palermo University Hospital;Unit of Medical Oncology, Oncology Department, ‘Pugliese-Ciaccio’ Hospital

关键词: non-small-cell lung cancer;    checkpoints inhibitors;    network meta-analysis;    systematic review;    frontline therapy;   

DOI  :  10.1016/j.esmoop.2022.100465

学科分类：社会科学、人文和艺术（综合）

来源: BMJ Publishing Group

【 摘 要 】

Background Frontline immune checkpoint inhibitors (ICI)-based regimens in non-oncogene-addicted non-small-cell lung cancer (NSCLC) have been deeply investigated. To rank the available therapeutic options, we carried out a systematic review and Bayesian meta-analysis.Methods A comprehensive search for randomized controlled trials (RCTs) of ICI regimens, and a pairwise and a network meta-analysis (NMA) with an all-comers and a stratified strategy were conducted. Endpoints were overall survival (OS), progression-free survival (PFS), objective response rate (ORR) and treatment-related adverse events (TRAEs).Results Nineteen RCTs involving 17 treatment regimens were included. For the all-comers population, pembrolizumab/chemotherapy (CT) and cemiplimab were most likely the best treatments. For programmed death-ligand 1 (PD-L1) 50% cemiplimab ranked first for OS. In non-squamous (NSQ), pembrolizumab with/without CT ranked first for OS; cemiplimab ranked worse than the unselected population. In squamous (SQ), pooled hazard ratio (HR) showed a better chance in improving efficacy for combination strategy, while monotherapy did not, except for cemiplimab that ranked second. Atezolizumab/CT/bevacizumab ranked first in most subgroups for PFS. Direct comparison showed a non-statistically significant benefit of ICI regimens for the liver metastases cohort in OS, with a good ranking for pembrolizumab/CT and atezolizumab/bevacizumab/CT. Regarding brain metastases, all ICI regimens demonstrated an improvement in OS and PFS compared to CT. Nivolumab/ipilimumab/CT ranked better in this subset.Conclusions Our meta-analysis updated on the most recent findings demonstrates that different ICI treatments rank differently in specific NSCLC settings (histology, biomarker and clinical presentation) offering a novel challenging scenario for clinical decision making and research planning.

【 授权许可】

CC BY|CC BY-NC-ND