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Meta-Analysis
. 2020 Jan 20;18(1):15.
doi: 10.1186/s12957-020-1792-4.

Smokers or non-smokers: who benefits more from immune checkpoint inhibitors in treatment of malignancies? An up-to-date meta-analysis

Jiahang Mo  1 , Xiao Hu  2 , Lihu Gu  3 , Bangsheng Chen  4 , Parikshit Asutosh Khadaroo  5 , Zefeng Shen  1 , Lei Dong  6 , Yuqi Lv  1 , Marylin Nyaradzo Chitumba  7 , Jiequan Liu  8
Affiliations
Meta-Analysis

Smokers or non-smokers: who benefits more from immune checkpoint inhibitors in treatment of malignancies? An up-to-date meta-analysis

Jiahang Mo et al. World J Surg Oncol. .

Abstract

Background: Immune checkpoint inhibitors, which are a milestone in anti-cancer therapy, have been applied in the treatment of multiple malignancies. Real-world data have suggested that smoking status may be associated with the efficacy of anti-PD-1/PD-L1 therapy. Hereby, to evaluate "smoking benefit or not", we included numerous high-quality randomized controlled clinical trials (RCTs) without any restriction on category.

Methods: A systematic search of online database was performed from July 2010 to July 2019. Eligible studies included phase II/III RCTs comparing PD-1/PD-L1 inhibitors with chemotherapy in the treatment of multiple carcinomas and contained subgroup analysis of smoking status. Then, related hazard ratios (HRs) with 95% confidence intervals (CIs) of overall survival (OS) were pooled.

Results: In the initial meta-analysis, compared with chemotherapy, the OS of non-smokers (HR, 0.81; 95% CI, 0.67-0.98) and smokers (HR, 0.77; 95% CI, 0.71-0.83) were significantly prolonged with PD-1/PD-L1 inhibitors. Outcomes from subgroup analysis showed that in anti-PD-1/PD-L1 monotherapy groups, non-smokers showed no significant improvement in OS (HR, 0.94; 95% CI, 0.83-1.06), while the OS of smokers was significantly prolonged (HR, 0.79; 95% CI, 0.74-0.85); in groups of PD-1/PD-L1 inhibitors combined with chemotherapy, the OS of non-smokers (HR, 0.45; 95% CI, 0.28-0.71) and smokers (HR, 0.72; 95% CI, 0.61-0.85) were significantly prolonged. Combined ipilimumab and chemotherapy showed no significance in both groups.

Conclusion: Smokers benefit from either anti-PD-1/PD-L1 monotherapy or the combined regimen compared with chemotherapy. Considering cost-effectiveness, monotherapy was recommended to smokers. For non-smokers, only the combined regimen was feasible in non-small cell lung cancer.

Keywords: Anti-PD-1/PD-L1; Immune checkpoint inhibitors; Immunotherapy; Meta-analysis; Smoking.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of literature screening process
Fig. 2
Fig. 2
Forest plot of the long-term prognostic outcomes of anti-PD-1/PD-L1 therapy (non-smoker vs. smoker), PNon-smoker = 0.029, PSmoker < 0.001
Fig. 3
Fig. 3
Forest plot of the long-term prognostic outcomes of anti-PD-1/PD-L1 monotherapy (non-smoker vs. smoker), PNon-smoker = 0.304, PSmoker < 0.001
Fig. 4
Fig. 4
Forest plot of the long-term prognostic outcomes of the combined regimen (Anti-PD-1/PD-L1+chemotherapy) (non-smoker vs. smoker), PNon-smoker = 0.001, PSmoker < 0.001
See this image and copyright information in PMC

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