Indirect comparison between immunotherapy alone and immunotherapy plus chemotherapy as first-line treatment for advanced non-small cell lung cancer: A systematic review
Creators
- Lingling Li1
- Shu Xia2
- Fei Xu3
- Yu Chen4
- Xiaoli Ren5
- Yu Liu2
- Yuan Chen2
Description
Objectives
Use of immune checkpoint inhibitors (ICIs) as first-line treatment for advanced (stage IIIB/IV) non-small cell lung cancer (NSCLC) remains controversial. Clinical trials comparing single-drug immunotherapy (IO) with immunotherapy plus chemotherapy (IC) are lacking. We aimed to compare the efficacy of IO alone with that of IC as first-line treatment for advanced NSCLC.
Design
Systematic review
Data sources
PubMed, the Cochrane Library, and Embase for related studies on NSCLC; ClinicalTrials.gov, American Society of Clinical Oncology Meeting Library, and World Conference on Lung Cancer for relevant conference abstracts.
Eligibility criteria
Articles meeting the following criteria were selected:
- (1) randomized controlled trials on NSCLC treatment,
- (2) all individuals in the studies had not received treatment previously, and
- (3) research on IO monotherapy using programmed death-1/programmed death ligand-1 (PD-L1) inhibitors or IC.
Data extraction and synthesis
After reading the original literature, two reviewers independently extracted the relevant information. The primary outcomes were progression-free survival (PFS), overall survival (OS), and objective response rate (ORR). We also extracted data on treatment-related adverse events and immune-related adverse events (irAEs).
Results
Overall, 10 randomized controlled clinical trials (n = 5765) were included. As first-line treatment for advanced NSCLC, IC tended to yield better PFS, OS, and ORR than did IO. Furthermore, IC yielded significantly better PFS than IO when tumor PD-L1 expression was at least 50% (HR: 1.81, 95% CI: 1.18–2.78) and yielded a better OS and PFS when tumor PD-L1 expression was at least 1%; IO resulted in fewer adverse events than did IC. However, the incidence of irAEs was higher for IO than for IC.
Conclusions
The findings of the indirect comparison indicate that IC as first-line treatment for advanced NSCLC is significantly more effective than IO in patients with PD-L1 expression in at least 50% of tumor cells.