Meta-analysis: combination therapy better for NSCLC

  • Zhou Y & al.
  • J Immunother Cancer
  • 22 Dec 2018

  • curated by Kelli Whitlock Burton
  • Univadis Clinical Summaries
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Takeaway

  • First-line treatment with chemotherapy plus immune checkpoint inhibitors that block the PD-1 (programmed cell death 1) and PD-L1 (programmed cell death 1 ligand 1) yielded significantly better OS and disease progression compared with chemotherapy alone, regardless of PD-L1 expression.
  • Combination therapy yielded significantly higher rates of treatment-related adverse evnts (AEs).

Why this matters

  • There is disagreement over whether the benefits of PD-1/PD-L1 inhibitors outweigh the increased toxicity from the treatment.

Study design

  • Meta-analysis of 6 randomized controlled trials with 3144 patients with advanced NSCLC.
  • Funding: National Key R&D Program of China; National Natural Science Funds of China, and others.

Key results

  • PD-1/PD-L1 inhibitors plus chemotherapy significantly reduced the risk of disease progression (HR, 0.62; P<.001 and was associated with a decrease in mortality ci compared chemotherapy alone.>
  • Objective response rate was significantly higher with PD-1/PD-L1 inhibitors plus chemotherapy vs chemotherapy alone (pooled relative ratio [RR], 1.56; P<.001>
  • Outcomes were improved with PD-1/PD-L1 inhibitors plus chemotherapy regardless of PD-L1 expression level.
  • Grade ≥3 treatment-related AEs were significantly more common with PD-1/PD-L1 inhibitors plus chemotherapy (pooled RR, 1.14; P=.007), as were treatment-related serious AEs (pooled RR, 1.70; P=.006).

Limitations

  • Patient selection bias and no individual patient data.

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