First-line immune-based combination therapies for advanced non-small cell lung cancer: A Bayesian network...

Area of Science:

• Oncology
• Immunotherapy
• Pharmacology

Background:

• Immune-based combination therapies have transformed advanced non-small cell lung cancer (NSCLC) treatment.
• Optimal first-line therapy selection remains uncertain regarding efficacy and safety.

Purpose of the Study:

• To evaluate and compare first-line immune-based combination therapies for advanced NSCLC.
• To determine the most effective treatment strategies based on programmed cell death-ligand 1 (PD-L1) expression levels.

Main Methods:

• A Bayesian network meta-analysis was performed on randomized controlled trials (RCTs).
• Fourteen trials involving 8467 patients were analyzed.

Main Results:

• For non-selective PD-L1 expression, no significant differences in overall survival (OS) were found, but IO + IO + Chemo showed the highest probability of being the best option (68%).
• IO + Anti-angio + Chemo demonstrated superior progression-free survival (PFS), objective response rate (ORR), and increased grade ≥3 treatment-related adverse events (TRAEs).
• In PD-L1-high cohorts, IO + Anti-angio + Chemo appeared optimal for OS, PFS, and ORR. For PD-L1-intermediate/negative cohorts, IO + IO + Chemo was favored for OS, while IO + Anti-angio + Chemo was favored for PFS.

Conclusions:

• IO + IO + Chemo holds potential for improving OS across NSCLC subtypes, particularly in PD-L1-intermediate/negative patients.
• IO + Anti-angio + Chemo excels in improving short-term survival but is associated with a higher incidence of severe adverse events.