Checkpoint inhibitors in advanced nonsmall-cell lung cancer; a Bayesian network meta-analysis

Area of Science:

• Oncology
• Clinical Trials
• Immunotherapy

Background:

• Checkpoint inhibitors (CPIs) have demonstrated improved survival outcomes for advanced non-small-cell lung cancer (NSCLC) compared to chemotherapy alone.
• The efficacy of various CPIs, dosages, and combinations in different clinical settings warrants comparative analysis.

Purpose of the Study:

• To conduct a network meta-analysis comparing indirect evidence of different CPIs in advanced NSCLC.
• To rank the efficacy of various CPIs and their combinations for survival endpoints.

Main Methods:

• Systematic search for randomized controlled trials comparing CPIs in advanced NSCLC.
• Extraction of survival endpoint data from included trials.
• Network meta-analysis and network meta-regression to compare and rank CPI efficacy.

Main Results:

• Analysis included 9220 patients from 16 trials.
• In the first-line setting, chemotherapy plus Pembrolizumab demonstrated the highest probability of efficacy for overall survival (HR=0.788, 95% CI=0.728-0.855).
• Various CPIs and combinations were ranked for efficacy in the second-line setting and for progression-free survival.

Conclusions:

• Significant differences in efficacy exist among CPIs, dosages, settings, and combinations.
• Quantification of these differences aims to inform and guide clinical practice for advanced NSCLC treatment.