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系统疗法的有效性和安全性对以前未经治疗的患者进行比较,PD-L1表达<1%高级NSCLC:系统性审查和网络元分析

Mengyun Zhou^1,2, Junfang Huang¹, Zhou Jin¹

¹Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China.

Translational lung cancer research

|December 10, 2025

概括

对于具有低PD-L1表达的高级非小细胞肺癌 (NSCLC),建议使用基于组织学的第一线治疗. 布利祖马布加上化疗和尼沃卢马布加上化疗加上贝瓦齐祖马布是非状NSCLC的最佳治疗方法,而尼沃卢马布加上伊皮利穆马布加上化疗是状NSCLC的最佳治疗方法.

科学领域:

在瘤学瘤学.
免疫治疗是一种免疫疗法.
临床试验临床试验

背景情况:

晚期非小细胞肺癌 (NSCLC) 具有编程细胞死亡配体1 (PD-L1) 表达率<1%并且没有可操作突变,通常会接受pembrolizumab加化疗 (Pembro-chemo) 作为标准护理.
新兴的治疗组合和试验数据表明潜在的替代品可能会挑战当前的标准,特别是在不同的NSCLC组织学类型.

研究的目的:

评估先进NSCLC的第一线治疗方法的疗效和安全性,PD-L1<1%,具体比较非状和状亚型.
为了确定最佳的治疗策略,超出目前的护理标准,为这个患者群体.

主要方法:

在PubMed,Ovid Medline,Cochrane Library和Embase进行了III期随机对照试验 (RCT) 的系统文献搜索,截至2025年8月15日.
包含的RCT集中在以前未接受治疗的晚期NSCLC,PD-L1<1%且没有EGFR/ALK变异,报告了总生存率 (OS),无进展生存率 (PFS) 和客观响应率 (ORR) 等疗效结果.
用SUCRA进行治疗排名,并使用Cochrane风险偏差2工具评估偏差风险.

主要成果:

在25个III期RCT中,有5815名参与者确定了21种一线治疗方法.
对于整体存活 (OS),布罗利祖马布+化疗+卡纳基努马布显示出潜力 (SUCRA=0.90),其次是尼沃卢马布+伊皮利穆马布 (SUCRA=0.78),两者都显示出与布罗化疗相比的非显著优势.
最佳无进展生存 (PFS) 方案包括尼沃卢马布 + 化疗 + 贝瓦西祖马布 (SUCRA=0.88) 和塞尔普鲁利马布 + 化疗 (SUCRA=0.87). 对于非状性NSCLC,Pembro-chemo对OS是最佳的 (SUCRA=0.90),而尼沃卢马布+化疗+贝瓦西祖马布优化了PFS (HR=0.52). 对于状NSCLC,nivolumab + ipilimumab ±化疗导致OS,而serplulimab +化疗导致PFS.

结论:

晚期NSCLC与PD-L1<1%的第一线治疗应根据组织学个性化,平衡疗效和毒性.
建议使用 pembrolizumab + 化疗和 nivolumab + 化疗 + bevacizumab 作为非状NSCLC的最佳第一线选择.
建议使用尼沃卢马布+伊皮利穆马布±化疗作为状NSCLC的最佳一线治疗方法.

关键词:

先进的非小细胞肺癌 (先进的NSCLC)作为一线的治疗方法.编程细胞死亡连接物 1 负 (PD-L1 负)

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