NSCLC: frontline chemo + immunotherapy combination best in meta-analysis

  • Liang H & al.
  • Int J Cancer
  • 24 Apr 2019

  • curated by Kelli Whitlock Burton
  • Univadis Clinical Summaries
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Takeaway

  • Frontline treatment with programmed cell death/programmed cell death-ligand (PD-1/L1) inhibitors plus chemotherapy yielded better outcomes for advanced NSCLC than either treatment alone.

Why this matters

  • This meta-analysis fills the gap left by the lack of direct comparisons.

Study design

  • Meta-analysis of 11 randomized controlled trials with 6731 patients with advanced NSCLC.
  • Funding: National Key R&D Program of China and others.

Key results

  • Overall, PD-1/L1 inhibitors offered no advantage over chemotherapy in PFS or OS.
  • Combined therapy yielded better PFS (HR, 0.64; 95% CI, 0.58-0.71) and OS (HR, 0.74; 95% CI, 0.62-0.89) than chemotherapy alone.
  • Combined therapy offered better PFS (HR, 0.71; 95% CI, 0.51-0.99), but not better OS than PD-1/L1 inhibitors alone.
  • Subgroup results:
    • PD-L1
    • PD-L1≥50%: Combined therapy better than chemotherapy for OS (HR, 0.61; 95% CI, 0.37-0.98) and PFS (HR, 0.51; 95% CI, 0.43-0.62) but only better for OS (HR, 0.47; 95% CI, 0.38-0.58) compared with PD-1/L1 inhibitors.
  • More treatment-related adverse events with combination therapy.

Limitations

  • Studies lacked a uniform method for testing PD-L1 expression.