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Meta-Analysis
. 2021 Mar 12;100(10):e19713.
doi: 10.1097/MD.0000000000019713.

Efficacy of immune checkpoint inhibitors in the treatment of non-small cell lung cancer patients with different genes mutation: A meta-analysis

Rui Zhang  1 , Jing Zhu, Ying Liu, Ying Xin, Ying Wang, Kai Niu, Huafang Wei
Affiliations
Meta-Analysis

Efficacy of immune checkpoint inhibitors in the treatment of non-small cell lung cancer patients with different genes mutation: A meta-analysis

Rui Zhang et al. Medicine (Baltimore). .

Abstract

Background: Latest clinical trials have proved the better overall survival (OS) for the use of immune checkpoint inhibitors verse chemotherapy in non-small cell lung cancer (NSCLC) patients. However, we still have no clear ideas of the factors which could affect the efficacy of immune checkpoint inhibitors. Cancer, essentially, is a disease related to genes mutation. Therefore, we conducted a systematic review and meta-analysis to compare efficacy of immune checkpoint inhibitors for NSCLC patients with different genes mutation.

Methods: PubMed, EMBASE, Web of Science, and the Cochrane Library databases were searched for all clinical trials in NSCLC until December 16, 2019. The hazard ratio (HR) and 95% confidence intervals (CIs) of OS or progression-free survival (PFS) were used.

Results: A total of 4453 patients from 7 randomized controlled trials (RCTs) were included. Immune checkpoint inhibitors significantly prolonged the OS (HR, 0.67; 95% CI, 0.60-0.67) in NSCLC patients having epidermal growth factor receptor (EGFR) wild-type versus chemotherapy. Meanwhile, they prolonged the OS (HR, 0.61; 95% CI, 0.39-0.94) in NSCLC patients with Kirsten rat sarcoma viral oncogene homolog (KRAS) mutation. No matter PD-L1 tumor proportion scores were >1% or <1%, immune checkpoint inhibitors were more effective than chemotherapy (HR, 0.64; 95% CI, 0.55-0.75).

Conclusion: Immune checkpoint inhibitors are more efficacious than chemotherapy in NSCLC patients with EGFR wild-type, KRAS mutation, and any PD-L1 tumor proportion scores.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flow diagram: selection process for the studies. NSCLC = non-small cell lung cancer, OS = overall survival, PFS = progression-free survival, RCT = randomized controlled trial.
Figure 2
Figure 2
The assessment of risk of bias.
Figure 3
Figure 3
The funnel plot of studies evaluating EGFR expression. EGFR = epidermal growth factor receptor.
Figure 4
Figure 4
The funnel plot of studies evaluating PD-L1 tumor proportion scores.
Figure 5
Figure 5
Forest plot for OS of NSCLC patients with EGFR mutation. EGFR = epidermal growth factor receptor, OS = overall survival, NSCLC = non-small cell lung cancer.
Figure 6
Figure 6
Forest plot for OS NSCLC patients with EGFR wild-type. EGFR = epidermal growth factor receptor, OS = overall survival, NSCLC = non-small cell lung cancer.
Figure 7
Figure 7
Forest plot for OS and PFS of NSCLC patients with KRAS mutation. NSCLC = non-small cell lung cancer, OS = overall survival, PFS = progression-free survival.
Figure 8
Figure 8
Forest plot for OS and PFS of NSCLC patients with KRS wild-type. NSCLC = non-small cell lung cancer, OS = overall survival, PFS = progression-free survival.
See this image and copyright information in PMC

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