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Effectiveness and Safety of Immune Checkpoint Inhibitors for Patients with Advanced Non Small-Cell Lung Cancer in
Manlio Mencoboni1, Marcello Ceppi2, Marco Bruzzone2
1SSD Oncologia Ospedale Villa Scassi, ASL 3 Genovese, 16149 Genova, Italy.
Abstract:
Immunotherapy based on anti PD-1/PD-L1 inhibitors is the new standard of advanced non-small cell lung cancers. Pembrolizumab, nivolumab and atezolizumab are used in clinical practice. The strict eligibility criteria of clinical trials do not allow researchers to fully represent treatment effects in the patients that will ultimately use these drugs. We performed a systematic review and a meta-analysis to evaluate the effectiveness and safety of these drugs, and more generally of ICIs, as second-line therapy in NSCLC patients in real world practice. MEDLINE, PubMed, Scopus and Web of Science were searched to include original studies published between January 2015 and April 2020. A total of 32 studies was included in the meta-analysis. The overall radiological response rate (ORR), disease control rate (DCR), median progression-free survival (PFS) and overall survival (OS) were 21%, 52%, 3.35 months and 9.98 months, respectively. The results did not change when analysis was adjusted for Eastern Cooperative Oncology Group performance status (ECOG PS) and age. A unitary increase in the percent of patients with liver and CNS metastases reduced the occurrence of DCR by 7% (p < 0.001) and the median PFS by 2% (p = 0.010), respectively. The meta-analysis showed that the efficacy and safety of immunotherapy in everyday practice is comparable to that in clinical trials.
Insights
Immunotherapy with PD-1/PD-L1 inhibitors shows real-world effectiveness in advanced non-small cell lung cancer. Real-world data for immune checkpoint inhibitors (ICIs) in NSCLC patients confirms efficacy comparable to clinical trials.
Area of Science:
- Oncology
- Immunology
- Pharmacology
Background:
- Anti PD-1/PD-L1 inhibitors are standard for advanced non-small cell lung cancer (NSCLC).
- Clinical trial eligibility criteria may not reflect real-world patient populations.
- Immune checkpoint inhibitors (ICIs) are increasingly used in clinical practice.
Purpose of the Study:
- To evaluate the real-world effectiveness and safety of anti PD-1/PD-L1 inhibitors in NSCLC.
- To compare real-world outcomes with clinical trial data for ICIs.
- To analyze factors influencing treatment outcomes in NSCLC patients receiving immunotherapy.
Main Methods:
- Systematic review and meta-analysis of 32 studies.
- Searched MEDLINE, PubMed, Scopus, and Web of Science (Jan 2015 - Apr 2020).
- Analyzed radiological response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and overall survival (OS).
Main Results:
- Overall ORR was 21%, DCR was 52%, median PFS was 3.35 months, and median OS was 9.98 months.
- Results remained consistent after adjusting for age and ECOG PS.
- Increased liver and CNS metastases correlated with reduced DCR and PFS.
Conclusions:
- Real-world efficacy and safety of ICIs in NSCLC are comparable to clinical trial findings.
- Immunotherapy demonstrates significant clinical benefit as second-line treatment for NSCLC.
- Patient characteristics like metastases location impact treatment outcomes.
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