- In advanced NSCLC, the addition of chemotherapy to immune checkpoint inhibitors (ICIs), especially pembrolizumab or atezolizumab, boosts efficacy as first-line treatment.
- Efficacy bump is most prominent with nonsquamous disease.
Why this matters
- The authors of this network meta-analysis (NMA) of 12 phase 3 studies say that the findings send a “very strong message” confirming evidence-based new standards of care for advanced NSCLC.
- For OS; 10 studies with different combinations vs chemotherapy alone, pooled HRs (95% CIs):
- Chemotherapy+pembrolizumab: pooled HR, 0.54 (0.46-0.64).
- Chemotherapy+atezolizumab (with/without bevacizumab):
- NMA estimated HR, 0.75 (0.59-0.94);
- Pooled HR, 0.85 (0.75-0.95).
- Pembrolizumab monotherapy: HR, 0.81 (0.71-0.93).
- NMA estimated pembrolizumab+chemotherapy as better than all other options: HRs, 0.51-0.72.
- Analyses by histological subtype showed similar OS results favoring pembrolizumab+chemotherapy, as did analyses by PD-L1 status (≥50%,
- PFS; primary outcome for the same groups/subsets largely also favored pembrolizumab or atezolizumab+chemotherapy.
- NMA of published data from 12 clinical trials of ICIs with/without chemotherapy (15 published studies or presentations) including 9236 patients with NSCLC.
- Funding: None.
- NMAs involve some indirect comparisons and require cautious interpretation.