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Strengths and weaknesses of immunotherapy for advanced non-small-cell lung cancer: a meta-analysis of 12 randomized
Juan Wang1, Ze-Hong Zou, Hong-Lin Xia
1Guangzhou Municipal Key Laboratory of Allergy and Clinical Immunology, Allergy Research Branch of the State Key Laboratory of Respiratory Disease, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Background:
Lung cancer is one of the leading causes of cancer death worldwide. Non-small-cell lung cancer (NSCLC) accounts for approximately 85% of all lung cancers. Immunotherapy has yielded no consistent benefit to date for those patients. Assessing the objective efficacy and safety of immunotherapy for advanced NSCLC patients will help to instruct the future development of immunotherapeutic drugs.
Methodology And Principal Findings:
We performed a meta-analysis of 12 randomized controlled trials including 3134 patients (1570 patients in the immunotherapy group and 1564 patients in the control group) with histologically confirmed stage IIIA, IIIB, or IV NSCLC. The analysis was executed with efficacy end points regarding overall survival (OS), progression-free survival (PFS), complete response (CR), partial response (PR), and total effective rate. Overall unstratified OS, PFS, PR, and total effective rate were significantly improved in advanced NSCLC patients in the immunotherapy group (P = 0.0007, 0.0004, 0.002, 0.003, respectively), whereas CR was not improved (P = 0.97). Subgroup analysis showed that monoclonal antibody (mAb) immunotherapy significantly improved the PFS, PR, and total effective rate and showed a trend of improving OS of advanced NSCLC patients compared with the control group, with one kind of adverse event being significantly dominant. Compared with the control group, the vaccine subgroup showed no significant difference with regard to serious adverse events, whereas cytokine immunotherapy significantly induced three kinds of serious adverse events.
Conclusions:
Immunotherapy works efficiently on advanced NSCLC patients. Of several immunotherapies, mAb therapy may be a potential immunotherapy for advanced NSCLC patients, and become a standard complementary therapeutic approach in the future if the issues concerning toxicity and allergenicity of mAbs have been overcome.
Insights
Immunotherapy shows significant benefits for advanced non-small-cell lung cancer (NSCLC) patients, improving survival and response rates. Monoclonal antibody therapy is a promising option, though toxicity concerns need addressing.
Area of Science:
- Oncology
- Immunology
- Clinical Trials
Background:
- Lung cancer is a leading cause of cancer death globally, with non-small-cell lung cancer (NSCLC) comprising 85% of cases.
- Current immunotherapy approaches have not consistently benefited advanced NSCLC patients.
- Evaluating immunotherapy's efficacy and safety is crucial for future drug development.
Purpose of the Study:
- To assess the objective efficacy and safety of immunotherapy in advanced NSCLC patients.
- To guide the development of novel immunotherapeutic drugs for lung cancer treatment.
Main Methods:
- A meta-analysis of 12 randomized controlled trials involving 3134 patients with stage IIIA, IIIB, or IV NSCLC.
- Efficacy endpoints included overall survival (OS), progression-free survival (PFS), complete response (CR), partial response (PR), and total effective rate.
- Subgroup analyses were conducted for different immunotherapy types, including monoclonal antibodies (mAbs), vaccines, and cytokines.
Main Results:
- Immunotherapy significantly improved OS, PFS, PR, and total effective rate in advanced NSCLC patients (P < 0.05).
- CR was not significantly improved (P = 0.97).
- Monoclonal antibody immunotherapy enhanced PFS, PR, and total effective rate, with a trend towards improved OS. Cytokine immunotherapy induced significant adverse events, while vaccine subgroups showed no significant difference in serious adverse events.
Conclusions:
- Immunotherapy is effective for advanced NSCLC patients.
- Monoclonal antibody therapy presents a potential treatment strategy for advanced NSCLC.
- Further research is needed to overcome toxicity and allergenicity issues associated with mAbs for broader clinical application.
