PMID- 33549014
OWN - NLM
STAT- MEDLINE
DCOM- 20210514
LR  - 20210514
IS  - 2224-5839 (Electronic)
IS  - 2224-5820 (Linking)
VI  - 10
IP  - 3
DP  - 2021 Mar
TI  - Efficacy and safety of first-line treatments with immune checkpoint inhibitors 
      plus chemotherapy for non-squamous non-small cell lung cancer: a meta-analysis 
      and indirect comparison.
PG  - 2766-2775
LID - 10.21037/apm-20-1498 [doi]
AB  - BACKGROUND: Recently, several clinical studies have evaluated the first-line use 
      of immune checkpoint inhibitors (ICIs) combined with platinum-doublet 
      chemotherapy in patients with non-squamous non-small cell lung cancer (NSCLC), 
      however, the differences in safety and efficacy between the various types of ICIs 
      still require investigation. In this study, we evaluated the efficacy and safety 
      of the first-line use of ICIs combined with platinum-doublet chemotherapy in 
      patients with non-squamous NSCLC by meta-analysis and indirect comparison. 
      METHODS: Literature searches were performed using PubMed, the Cochrane Library, 
      Embase, China Knowledge Resource Integrated Database, and Wanfang Data to 
      identify all relevant randomized clinical trials for non-squamous NSCLC after 
      2010. Overall survival (OS), progression-free survival (PFS), and adverse effects 
      (AEs) were pooled for meta-analysis and indirect comparison. Subgroup analyses 
      were conducted to examine the factors associated with PFS. RESULTS: The 
      meta-analysis showed that the additional use of ICIs could significantly improve 
      PFS and OS. The indirect comparison showed no significant difference in 
      pembrolizumab + chemotherapy and atezolizumab + chemotherapy in the reducing of 
      disease progression, while a significant difference in restricted mean survival 
      time (RMST) was found between pembrolizumab + chemotherapy compared with 
      atezolizumab + chemotherapy. A significant increase in grade >/=3 AEs was observed 
      with the additional use of atezolizumab combined with chemotherapy. Subgroups 
      including PD-1 status [high (>50%), intermediate (1-49%), and negative (<1%) 
      expression], sex (male and female), smoking status (current or former smoker, and 
      never smoked), liver metastases (with and without), age (>65 and </=65) and Eastern 
      Cooperative Oncology Group (ECOG) score (ECOG=0 and ECOG=1) were all associated 
      with better PFS. CONCLUSIONS: This meta-analysis confirmed the treatment effects 
      of ICIs combined with chemotherapy for non-squamous NSCLC. The pembrolizumab 
      combination group had a greater RMST benefit compared with the atezolizumab 
      combination group. Furthermore, our study also demonstrated a PFS advantage for 
      non-squamous NSCLC using ICIs combined with chemotherapy irrespective of 
      programmed death-ligand 1 (PD-L1) expression level, smoking status, liver 
      metastasis status, sex, age and ECOG score. Due to the significant increase in 
      AEs (> grade 3), more attention should be paid to the additional use of 
      atezolizumab.
FAU - Shi, Yafei
AU  - Shi Y
AD  - Department of Pharmacy, National Cancer Center/National Clinical Research Center 
      for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union 
      Medical College, Beijing, China.
FAU - Chen, Wei
AU  - Chen W
AD  - Department of Pharmacy, National Cancer Center/National Clinical Research Center 
      for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union 
      Medical College, Beijing, China.
FAU - Li, Chunyu
AU  - Li C
AD  - Department of Pharmacy, National Cancer Center/National Clinical Research Center 
      for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union 
      Medical College, Beijing, China.
FAU - Zhang, Yujun
AU  - Zhang Y
AD  - Department of Pharmacy, National Cancer Center/National Clinical Research Center 
      for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union 
      Medical College, Beijing, China.
FAU - Bo, Mingming
AU  - Bo M
AD  - Department of Pharmacy, National Cancer Center/National Clinical Research Center 
      for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union 
      Medical College, Beijing, China.
FAU - Qi, Shuya
AU  - Qi S
AD  - Department of Pharmacy, National Cancer Center/National Clinical Research Center 
      for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union 
      Medical College, Beijing, China.
FAU - Li, Guohui
AU  - Li G
AD  - Department of Pharmacy, National Cancer Center/National Clinical Research Center 
      for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union 
      Medical College, Beijing, China. lgh0603@cicams.ac.cn.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
DEP - 20210201
PL  - China
TA  - Ann Palliat Med
JT  - Annals of palliative medicine
JID - 101585484
RN  - 0 (Immune Checkpoint Inhibitors)
SB  - IM
MH  - *Carcinoma, Non-Small-Cell Lung/drug therapy
MH  - China
MH  - Female
MH  - Humans
MH  - Immune Checkpoint Inhibitors
MH  - Immunotherapy
MH  - *Lung Neoplasms/drug therapy
MH  - Male
OTO - NOTNLM
OT  - Non-squamous non-small cell lung cancer (non-squamous NSCLC)
OT  - efficacy
OT  - first-line
OT  - immune checkpoint inhibitors (ICIs)
OT  - safety
EDAT- 2021/02/08 06:00
MHDA- 2021/05/15 06:00
CRDT- 2021/02/07 20:25
PHST- 2020/07/28 00:00 [received]
PHST- 2020/12/08 00:00 [accepted]
PHST- 2021/02/08 06:00 [pubmed]
PHST- 2021/05/15 06:00 [medline]
PHST- 2021/02/07 20:25 [entrez]
AID - apm-20-1498 [pii]
AID - 10.21037/apm-20-1498 [doi]
PST - ppublish
SO  - Ann Palliat Med. 2021 Mar;10(3):2766-2775. doi: 10.21037/apm-20-1498. Epub 2021 
      Feb 1.