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A network meta-analysis of immunotherapy-based treatments for advanced nonsquamous non-small cell lung cancer
Himani Aggarwal1, Kerigo Ndirangu2, Katherine B Winfree1
1Eli Lilly & Company, 893 S Delaware Street Indianapolis, IN 46225, USA.
Abstract:
Introduction: In the absence of head-to-head trials comparing immunotherapies for advanced nonsquamous non-small-cell lung cancer (NsqNSCLC), a network meta-analysis (NMA) was conducted to compare the relative efficacy of these treatments. Materials & methods: A systematic literature review of randomized controlled trials evaluating first-line-to-progression and second-line treatments for advanced NsqNSCLC informed Bayesian NMAs for overall survival (OS) and progression-free survival (PFS) end points. Results: Among first-line-to-progression treatments, pembrolizumab + pemetrexed + platinum showed the greatest OS benefit versus other regimens and a PFS benefit versus all but three regimens. Among second-line treatments, an OS benefit was seen for atezolizumab, nivolumab and pembrolizumab versus docetaxel. Conclusion: Pembrolizumab + pemetrexed + platinum showed the maximum OS benefit in the first-line setting. In the second-line setting, anti-PD-1/anti-PD-L1 monotherapies were better than docetaxel.
Insights
This network meta-analysis found that pembrolizumab plus chemotherapy offers the greatest overall survival benefit for advanced nonsquamous non-small-cell lung cancer in the first-line setting. In the second-line setting, anti-PD-1/anti-PD-L1 immunotherapies outperformed docetaxel.
Area of Science:
- Oncology
- Immunotherapy
- Clinical Trials
Background:
- Advanced nonsquamous non-small-cell lung cancer (NsqNSCLC) lacks direct comparative trials for immunotherapies.
- Network meta-analysis (NMA) is crucial for evaluating relative treatment efficacy in such scenarios.
Approach:
- A systematic literature review identified relevant randomized controlled trials.
- Bayesian NMAs assessed overall survival (OS) and progression-free survival (PFS) for first- and second-line treatments.
- The analysis included immunotherapies and chemotherapy regimens.
Key Points:
- First-line: Pembrolizumab + chemotherapy demonstrated superior OS and PFS benefits compared to other regimens.
- Second-line: Anti-PD-1/anti-PD-L1 monotherapies (atezolizumab, nivolumab, pembrolizumab) showed improved OS versus docetaxel.
Conclusions:
- Pembrolizumab plus chemotherapy is the optimal first-line treatment for advanced NsqNSCLC based on OS.
- Anti-PD-1/anti-PD-L1 immunotherapies represent a more effective second-line option than docetaxel.
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