Lung cancer plus liver metastasis: Combined therapy or not?

  • Qin BD & al.
  • Crit Rev Oncol Hematol
  • 30 Jan 2020

  • curated by Kelli Whitlock Burton
  • Univadis Clinical Summaries
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Takeaway

  • First-line treatment with a combined therapy of a programmed cell death protein 1/ligand 1 (PD-1/PD-L1) inhibitor plus chemotherapy produced similar outcomes in lung cancer patients with and without liver metastases.

Why this matters

  • Previous studies of immunotherapy in lung cancer with liver metastases have yielded mixed results, but these findings suggest the presence of liver metastases should not be a deciding factor in whether to prescribe combined treatment.

Study design

  • Meta-analysis of 8 RCTs with 4485 lung cancer patients.
  • Funding not disclosed.

Key results

  • Overall, combined therapy yielded significantly better PFS (pooled HRs, 0.63; 95% CI, 0.58-0.67) and OS (pooled HRs, 0.67; 95% CI, 0.57-0.78) compared to chemotherapy alone.
  • Although patients with liver metastases had a smaller survival benefit with combined therapy, the difference was not significant:
    • Without liver metastases: PFS HR, 0.60; 95% CI, 0.55-0.65 and OS HR, 0.70; 95% CI, 0.62-0.80.
    • With liver metastases: PFS HR, 0.69; 95% CI, 0.58-0.81 and OS HR, 0.79; 95% CI, 0.62-0.80.
    • Pooled ratios in patients with liver metastases vs those without for PFS was HR, 1.11; 95% CI, 0.92-1.34 and for OS was HR, 1.03; 95% CI, 0.80-1.35.
  • Similar efficacy was found when pathological type subsets of NSCLC patients were analyzed.

Limitations

  • Retrospective study.