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. 2018 Oct 31:11:7691-7697.
doi: 10.2147/OTT.S171072. eCollection 2018.

A meta-analysis of nivolumab for the treatment of advanced non-small-cell lung cancer

Shuo Chen  1 , Bin Hu  1 , Hui Li  1
Affiliations

A meta-analysis of nivolumab for the treatment of advanced non-small-cell lung cancer

Shuo Chen et al. Onco Targets Ther. .

Abstract

Background: Non-small-cell lung cancer (NSCLC) is often associated with rapid progression following standard chemotherapy. Nivolumab, an inhibitor of PD-1/PD-L1, is reported to have potential efficacy for the treatment NSCLC.

Objective: The purpose of this meta-analysis was to systematically evaluate the efficacy and safety of nivolumab in patients with advanced NSCLC.

Methods: Online electronic databases were searched in June 2017, including: PubMed, Embase, and the Cochrane Library. Randomized controlled trials were included that compared nivolumab to chemotherapy in NSCLC patients with regard to oncological outcome profiles. Review Manager Version 5.3 software was used.

Results: Three studies were included in this analysis, comprising 1,395 patients with NSCLC, of whom 698 received nivolumab and 697 received chemotherapy without nivolumab. The pooled hazard ratios for overall survival (OS) and prolonged progression-free survival (PFS) were 0.77 (95% CI: 0.57-1.03; P=0.08) and 0.88 (95% CI: 0.64-1.20; P=0.41), respectively. The pooled odds ratio for overall response rate was 1.40 (95% CI: 0.66-2.96; P=0.39), indicating that no benefit with nivolumab was found for OS, PFS, or overall response rate. However, the odds ratio for treatment-related adverse events, grades 3 or 4, between the patients who received nivolumab and chemotherapy was 0.13 (95% CI: 0.09-0.17; P<0.00001). For patients with a PD-L1 expression level of 5% or more, no difference was observed in PFS (95% CI: 0.70-1.00; P=0.05) and OS benefit (95% CI: 0.34-1.15; P=0.13) between the groups.

Conclusion: These data demonstrate no clinical survival benefit with nivolumab for NSCLC patients, even in a subpopulation of patients with levels of PD-L1>5%. However, nivolumab had a more favorable safety profile than chemotherapy. Future investigations are needed to determine whether the efficacy of nivolumab can be improved.

Keywords: PD-1; meta-analysis; nivolumab; non-small-cell lung cancer.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
PRISMA flow chart of the selection process for identification of eligible studies for pooling. Abbreviations: PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RCT, randomized controlled trial.
Figure 2
Figure 2
Pooled analysis of PFS comparing the addition of nivolumab with chemotherapy. Abbreviations: OR, odds ratio; PFS, progression-free survival.
Figure 3
Figure 3
Pooled analysis of OS comparing the addition of nivolumab with chemotherapy. Abbreviations: OR, odds ratio; OS, overall survival.
Figure 4
Figure 4
Pooled analysis of ORR comparing the addition of nivolumab with chemotherapy. Abbreviations: OR, odds ratio; ORR, overall response rate.
Figure 5
Figure 5
Pooled analysis of SAEs comparing the addition of nivolumab with chemotherapy. Abbreviations: OR, odds ratio; SAE, serious adverse effect.
Figure 6
Figure 6
Subgroup meta-analysis of PFS among patients with PD-L1 expression level of ≥5%. Abbreviations: OR, odds ratio; PFS, progression-free survival.
Figure 7
Figure 7
Subgroup meta-analysis of OS among patients with PD-L1 expression level of ≥5%. Abbreviations: OR, odds ratio; OS, overall survival.
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