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Published on: December 1, 2016
Efficacy and safety of immune checkpoint inhibitors in non-small cell lung cancer
Shuai Wang1, Jiatao Hao2, Hao Wang1
1Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Abstract:
Immune checkpoint inhibitors (ICIs) are new therapeutic strategies for non-small cell lung cancer (NSCLC). We aimed to quantitatively evaluate the efficacy and safety of ICIs in NSCLC. Pubmed, Embase, Cochrane Library, and Web of Science were searched for randomized clinical trials comparing ICIs with control therapies in NSCLC. Data were pooled according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. A total of 12 trails comprising 6,919 NSCLC patients were included in this meta-analysis. ICIs therapies significantly improved progression-free survival (PFS) (HR, 0.838; P < 0.001), overall survival (OS) (HR, 0.747; P < 0.001) and objective response rates (ORR) (RR, 1.311; P < 0.001) in NSCLC. Prognostic benefit was observed irrespective of age, sex, treatment line, performance status and histology. Survival improvement of ICIs was limited for NSCLC patients with non-smoker (PFS, P = 0.468; OS, P = 0.317) or central nervous system (CNS) metastasis (PFS, P = 0.209; OS, P = 0.090), or positive EGFR mutation (PFS, P = 0.083; OS, P = 0.522) or PD-L1 expression level less than 5% (PFS, P = 0.370; OS, P = 0.047). The relative risks of all-grade and high-grade (≥3) anemia, neutropenia, leukopenia, thrombocytopenia, stomatitis, nausea, pyrexia, asthenia and neuropathy were all decreased in patients received ICIs compared with control therapies. This meta-analysis provides clinical evidence that ICIs improve PFS, OS, and ORR in NSCLC with fewer adverse effects. Our data establish ICIs as a prefer treatment option for NSCLC patients with smoker, no CNS metastasis, wild type EGFR, and high PD-L1 expression.
Insights
Immune checkpoint inhibitors (ICIs) significantly improve survival and response rates in non-small cell lung cancer (NSCLC). These therapies show fewer adverse effects, establishing them as a preferred treatment for specific NSCLC patient groups.
Area of Science:
- Oncology
- Immunotherapy
- Clinical Trials
Background:
- Non-small cell lung cancer (NSCLC) is a leading cause of cancer mortality.
- Immune checkpoint inhibitors (ICIs) represent a novel therapeutic class for NSCLC.
- Quantitative evaluation of ICI efficacy and safety in NSCLC is crucial.
Purpose of the Study:
- To quantitatively assess the efficacy and safety of immune checkpoint inhibitors (ICIs) in non-small cell lung cancer (NSCLC).
- To identify patient subgroups that benefit most from ICI therapy.
Main Methods:
- Systematic search of PubMed, Embase, Cochrane Library, and Web of Science for randomized clinical trials.
- Meta-analysis of 12 trials including 6,919 NSCLC patients, adhering to PRISMA guidelines.
- Pooled analysis of progression-free survival (PFS), overall survival (OS), objective response rates (ORR), and adverse events.
Main Results:
- ICIs significantly improved PFS (HR 0.838), OS (HR 0.747), and ORR (RR 1.311) in NSCLC patients.
- Benefits were observed across various demographics and clinical factors, but were limited in non-smokers, patients with CNS metastasis, EGFR mutations, or low PD-L1 expression.
- ICIs demonstrated a reduced risk of several adverse events, including anemia, neutropenia, and nausea, compared to control therapies.
Conclusions:
- Immune checkpoint inhibitors (ICIs) enhance PFS, OS, and ORR in NSCLC patients with a favorable safety profile.
- ICIs are a preferred treatment option for NSCLC patients who are smokers, have no CNS metastasis, wild-type EGFR, and high PD-L1 expression.
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