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Published on: September 25, 2018
Which Is More Suitable for First-Line Treatment of Extensive-Stage Small Cell Lung Cancer, PD-L1 Inhibitors Versus
Wenjing Liu1, Lulin Yu1, Yuqian Feng1
1Department of Medical Oncology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
Background:
In this network meta-analysis (NMA), the efficiency and safety of PD-1 inhibitors + chemotherapy and PD-L1 inhibitors + chemotherapy were compared in the first-line therapy of patients with extensive-stage small cell lung cancer (ES-SCLC).
Methods:
We searched research databases, conference abstracts, and trial registries and subsequently chose relevant studies and extracted dates. The NMA was conducted to estimate the efficiency and safety of the PD-1 inhibitors + chemotherapy and PD-L1 inhibitors + chemotherapy on overall survival (OS), progression-free survival (PFS), overall remission rate (ORR), and adverse events (AEs). Studies were assessed for quality. Subgroup analyses were used to evaluate study heterogeneity.
Results:
We included six randomized trials with a total of 3163 patients. Direct comparisons showed that patients who received either PD-1 inhibitors + chemotherapy (HR: 0.71, 95% CI: 0.57-0.87) or PD-L1 inhibitors + chemotherapy (HR: 0.74, 0.61-0.89) demonstrated significantly longer OS than those who received placebo + chemotherapy. The results of the NMA showed that no significant differences in OS (HR 0.96 95% CI: 0.72-1.3), PFS (HR 0.83, 95% CI: 0.51-1.4), and ORR (OR 1.3 95% CI: 0.66-2.5) were observed for PD-1 inhibitors + chemotherapy compared with PD-L1 inhibitors + chemotherapy, but the Bayesian ranking revealed that patients receiving PD-1 inhibitors + chemotherapy tended to have longer OS, PFS benefit, and better treatment response than patients receiving PD-L1 inhibitors + chemotherapy. In terms of safety, no significant difference was observed in their safety profiles.
Conclusion:
In comparison to placebo + chemotherapy, PD-L1 inhibitors + chemotherapy and PD-1 inhibitors + chemotherapy significantly improved survival for ES-SCLC. According to the available data, PD-L1 inhibitors + chemotherapy and PD-1 inhibitors + chemotherapy had equivalent efficacy and safety; however, the level of evidence of this type of comparison is limited.
Insights
Both PD-1 and PD-L1 inhibitors combined with chemotherapy significantly improve survival in extensive-stage small cell lung cancer (ES-SCLC). Network meta-analysis indicates comparable efficacy and safety between PD-1 and PD-L1 inhibitors in first-line ES-SCLC treatment.
Area of Science:
- Oncology
- Immunotherapy
- Clinical Trials
Background:
- Extensive-stage small cell lung cancer (ES-SCLC) presents a significant therapeutic challenge.
- First-line treatment options are crucial for improving patient outcomes in ES-SCLC.
Purpose of the Study:
- To compare the efficacy and safety of PD-1 inhibitors plus chemotherapy versus PD-L1 inhibitors plus chemotherapy in first-line ES-SCLC treatment.
- To evaluate the impact of these immunotherapies on overall survival (OS), progression-free survival (PFS), and overall remission rate (ORR).
Main Methods:
- A network meta-analysis (NMA) was conducted, synthesizing data from six randomized controlled trials involving 3163 patients.
- Systematic literature searches were performed across databases, conference abstracts, and trial registries.
- Study quality was assessed, and subgroup analyses were employed to address heterogeneity.
Main Results:
- Both PD-1 inhibitors + chemotherapy and PD-L1 inhibitors + chemotherapy significantly improved OS compared to placebo + chemotherapy.
- The NMA revealed no statistically significant differences in OS, PFS, or ORR between PD-1 and PD-L1 inhibitors + chemotherapy.
- Bayesian ranking suggested a trend towards improved OS and PFS with PD-1 inhibitors + chemotherapy, alongside better response rates. Safety profiles were comparable between the two regimens.
Conclusions:
- PD-1 and PD-L1 inhibitors combined with chemotherapy represent effective first-line treatments for ES-SCLC, significantly improving survival.
- Current evidence suggests equivalent efficacy and safety between PD-1 and PD-L1 inhibitors in this setting, though the level of evidence for direct comparison is limited.
