PMID- 37596898
OWN - NLM
STAT- MEDLINE
DCOM- 20230921
LR  - 20230922
IS  - 2542-5641 (Electronic)
IS  - 0366-6999 (Print)
IS  - 0366-6999 (Linking)
VI  - 136
IP  - 18
DP  - 2023 Sep 20
TI  - Efficacy and safety of immune checkpoint inhibitors for advanced non-small cell 
      lung cancer with or without PD-L1 selection: A systematic review and network 
      meta-analysis.
PG  - 2156-2165
LID - 10.1097/CM9.0000000000002750 [doi]
AB  - BACKGROUND: Immune checkpoint inhibitors (ICIs) are standard treatments for 
      advanced non-small cell lung cancer (NSCLC); however, evidence regarding their 
      relative efficacy and safety is lacking. This study compared the efficacy and 
      safety of all currently available ICI treatments in patients with advanced NSCLC 
      to identify optimal treatment regimens. METHODS: PubMed, Cochrane Central 
      Register of Controlled Trials (CENTRAL), MEDLINE, and Embase databases were 
      systematically searched for randomized controlled trials (RCTs) published up to 
      August 8, 2022. The primary outcomes were overall survival (OS) and 
      progression-free survival (PFS). Secondary outcomes included objective response 
      rate (ORR) and adverse events (AEs). RESULTS: Forty RCTs involving 22,526 
      patients were selected, and a total of 26 treatment regimens were identified. 
      Treatment with anti-programmed cell death protein-1 (anti-PD-1) provided superior 
      OS compared with anti-programmed death ligand 1 (anti-PD-L1) treatment. ICIs plus 
      platinum-based chemotherapy (PBC) were superior to ICIs treatment alone, although 
      the addition of PBC increased treatment toxicity. Cemiplimab ranked first for OS 
      and lowest for any-grade AEs in advanced NSCLC patients without PD-L1 selection. 
      Regarding grade >/=3 AEs, the toxicity of ICI monotherapy or ICI-ICI combination 
      was consistently lower than that of the other treatments. For patients without 
      PD-L1 selection, cemiplimab showed the best OS, pembrolizumab plus docetaxel 
      (Pem-DXT) showed the best PFS, and atezolizumab plus bevacizumab and PBC 
      (Atezo-Beva-PBC) showed the best ORR. Pembrolizumab plus PBC and Atezo-Beva-PBC 
      were the most likely optimal treatments for OS and PFS in patients with PD-L1 
      expression <1%, respectively. In patients with PD-L1 expression >/=1%, treatment 
      regimens containing anti-PD-1 provided superior OS benefits compared with those 
      of anti-PD-L1 treatment, and sintilimab plus PBC (Sint-PBC) provided the best OS 
      benefit; as for PFS, ICI plus PBC consistently showed greater PFS benefits than 
      ICI or PBC alone. For patients with anti-PD-L1 expression of 1-49%, camrelizumab 
      plus PBC provided the best benefit for OS and PFS among included treatment. 
      Durvalumab-tremelimumab-PBC and Atezo-Beva-PBC respectively presented the highest 
      OS and PFS for patients with PD-L1 expression >/=50%. Moreover, cemiplimab and 
      Atezo-Beva-PBC yielded the best OS and PFS benefits as first-line treatments for 
      patients with advanced NSCLC, respectively. CONCLUSIONS: Although ICI plus PBC 
      likely resulted in superior survival outcomes compared to ICI treatment alone, it 
      did increase toxicity. Cemiplimab presented a well-balanced efficacy and safety 
      profile in advanced NSCLC treatment. Our findings with the current ICIs 
      comparisons will aid future trials for cancer immunotherapy. REGISTRATION: 
      PROSPERO, https://www.crd.york.ac.uk/PROSPERO/ , CRD42022323879.
CI  - Copyright (c) 2023 The Chinese Medical Association, produced by Wolters Kluwer, 
      Inc. under the CC-BY-NC-ND license.
FAU - Li, Yan
AU  - Li Y
AD  - Department of Pharmacy, Guangxi Academy of Medical Sciences and the People's 
      Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, China.
FAU - Liang, Xueyan
AU  - Liang X
AD  - Phase 1 Clinical Trial Laboratory, Guangxi Academy of Medical Sciences and the 
      People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, 
      China.
FAU - Li, Huijuan
AU  - Li H
AD  - Phase 1 Clinical Trial Laboratory, Guangxi Academy of Medical Sciences and the 
      People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, 
      China.
FAU - Chen, Xiaoyu
AU  - Chen X
AD  - Department of Pharmacy, Guangxi Academy of Medical Sciences and the People's 
      Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, China.
AD  - Phase 1 Clinical Trial Laboratory, Guangxi Academy of Medical Sciences and the 
      People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, 
      China.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20230818
PL  - China
TA  - Chin Med J (Engl)
JT  - Chinese medical journal
JID - 7513795
RN  - 0 (Immune Checkpoint Inhibitors)
RN  - 0 (CD274 protein, human)
SB  - IM
MH  - Humans
MH  - Immune Checkpoint Inhibitors/adverse effects
MH  - *Carcinoma, Non-Small-Cell Lung/drug therapy
MH  - Network Meta-Analysis
MH  - *Lung Neoplasms/drug therapy
PMC - PMC10508436
COIS- None.
EDAT- 2023/08/19 20:42
MHDA- 2023/09/21 06:42
PMCR- 2023/09/20
CRDT- 2023/08/19 06:33
PHST- 2022/12/27 00:00 [received]
PHST- 2023/09/21 06:42 [medline]
PHST- 2023/08/19 20:42 [pubmed]
PHST- 2023/08/19 06:33 [entrez]
PHST- 2023/09/20 00:00 [pmc-release]
AID - 00029330-202309200-00003 [pii]
AID - CMJ-2022-2989 [pii]
AID - 10.1097/CM9.0000000000002750 [doi]
PST - ppublish
SO  - Chin Med J (Engl). 2023 Sep 20;136(18):2156-2165. doi: 
      10.1097/CM9.0000000000002750. Epub 2023 Aug 18.