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Comparative Efficacy and Safety of PD-1/PD-L1 Inhibitors for Patients with Solid Tumors: A Systematic Review and

Qingyuan Huang1,2,3, Yuzhen Zheng4,5, Zhendong Gao1,2,3

  • 1Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China.

Journal of Cancer
|January 14, 2021
PubMed

Insights

This study compared programmed death 1 (PD-1)/programmed death ligand 1 (PD-L1) inhibitors for solid tumors. Nivolumab, pembrolizumab, atezolizumab, and durvalumab showed similar survival benefits, while avelumab was less effective. All inhibitors were comparable in safety and safer than traditional treatments.

Area of Science:

  • Oncology
  • Immunotherapy
  • Pharmacological Research

Background:

  • The clinical application of programmed death 1 (PD-1)/programmed death ligand 1 (PD-L1) inhibitors is expanding rapidly.
  • The comparative efficacy and safety of these immunotherapies remain unclear.
  • A comprehensive analysis is needed to guide clinical decision-making.

Purpose of the Study:

  • To systematically compare the efficacy and safety of various PD-1/PD-L1 inhibitors in patients with solid tumors.
  • To conduct a Bayesian network meta-analysis to synthesize evidence from randomized controlled trials.
  • To evaluate overall survival (OS), progression-free survival (PFS), and treatment-related adverse events (TrAEs).

Main Methods:

  • Systematic literature search of PubMed, Web of Knowledge, and other sources for relevant randomized controlled trials.
  • Inclusion of five PD-1/PD-L1 inhibitors in patients with solid tumors, published before November 30, 2018.
  • Bayesian network meta-analysis using random-effects models to estimate hazard ratios (HRs) for OS and PFS, and odds ratios (ORs) for grade 3-5 TrAEs.

Main Results:

  • Analysis included 35 trials with 21,261 patients.
  • Nivolumab, pembrolizumab, atezolizumab, and durvalumab demonstrated comparable efficacy in OS and PFS.
  • Avelumab showed significantly inferior OS and PFS compared to nivolumab and pembrolizumab. All PD-1/PD-L1 inhibitors were comparable in safety and reduced grade 3-5 TrAEs compared to standard-of-care.

Conclusions:

  • Nivolumab, pembrolizumab, atezolizumab, and durvalumab offer equivalent survival benefits in solid tumors.
  • Avelumab is associated with less favorable survival outcomes compared to other PD-1/PD-L1 inhibitors.
  • PD-1/PD-L1 inhibitors demonstrate comparable safety profiles and are generally safer than conventional therapies regarding severe adverse events.

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