Relative Efficacy of Checkpoint Inhibitors for Advanced NSCLC According to Programmed Death-Ligand-1 Expression: A...

Area of Science:

• Oncology
• Immunotherapy
• Biomarkers

Background:

• Immune checkpoint inhibitors (ICIs) are standard treatments for advanced non-small cell lung cancer (NSCLC).
• The efficacy of ICIs based on programmed death-ligand-1 (PD-L1) expression levels is not fully understood.
• Optimal patient selection for ICI therapy requires further investigation.

Purpose of the Study:

• To evaluate the survival benefit of ICIs compared to chemotherapy in advanced NSCLC.
• To assess the comparative efficacy of different ICIs based on PD-L1 expression levels (<1%, 1-49%, ≥50%).
• To identify reliable PD-L1 expression thresholds for patient selection and cost-effective treatment.

Main Methods:

• A Bayesian network meta-analysis (NMA) was conducted on seven randomized controlled trials.
• Data from 3688 patients with advanced NSCLC were analyzed.
• Hazard ratios (HRs) for overall survival (OS) were estimated with 95% credible intervals (CrIs).

Main Results:

• ICIs demonstrated a significant survival benefit over chemotherapy, particularly in the PD-L1 ≥50% subgroup.
• Atezolizumab, nivolumab, and nivolumab were identified as the most effective agents in the PD-L1 <1%, 1-49%, and ≥50% subgroups, respectively.
• PD-L1 expression ≥50% emerged as a reliable indicator for patient selection, enhancing cost-efficiency.

Conclusions:

• High PD-L1 expression (≥50%) is associated with a greater survival benefit from ICIs in advanced NSCLC.
• Specific ICIs can be recommended based on PD-L1 expression levels for optimized treatment outcomes.
• PD-L1 testing is crucial for guiding ICI therapy selection in advanced NSCLC for improved efficacy and cost-effectiveness.