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. 2022 Sep;127(5):948-956.
doi: 10.1038/s41416-022-01832-4. Epub 2022 May 31.

Immune checkpoint inhibitors alone vs immune checkpoint inhibitors-combined chemotherapy for NSCLC patients with high PD-L1 expression: a network meta-analysis

Yimin Wang #  1 , Hedong Han #  2 , Fang Zhang  2 , Tangfeng Lv  2 , Ping Zhan  2 , Mingxiang Ye  2 , Yong Song  3   4 , Hongbing Liu  5
Affiliations

Immune checkpoint inhibitors alone vs immune checkpoint inhibitors-combined chemotherapy for NSCLC patients with high PD-L1 expression: a network meta-analysis

Yimin Wang et al. Br J Cancer. 2022 Sep.

Abstract

Background: We indirectly compared the effects of immune checkpoint inhibitors alone (ICI) and ICI-combined chemotherapy (chemo-ICI) in patients with non-small cell lung cancer who had high programmed death-ligand 1 (PD-L1) expression (defined as tumour proportion score ≥50% or TC3/IC3) through network meta-analyses.

Methods: Through literature searches, we shortlisted 22 randomised controlled trials encompassing 4289 patients, with objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) set as the primary outcomes. The dichotomous data for ORR and hazard ratios (HRs) and their 95% confidence intervals (CIs) for OS and PFS were extracted.

Results: We found that chemo-ICI had significantly improved ORR (OR 1.7, 95% CI 1.1-2.5) and PFS (HR 0.59, 95% CI: 0.48-0.74) relative to ICI. Although no significant difference in OS was observed, the analyses revealed that the chemo-ICI patients tended to undergo fewer progression events than ICI patients (HR 0.82, 95% CI 0.6-1.1). In subgroup analysis, the non-squamous, PD-1 inhibitor and first-line treatment cohorts exhibited significant differences in ORR and PFS, but not in OS. However, in the squamous, PD-L1 inhibitor, and previously treated cohorts, PFS, OS and ORR were not different between chemo-ICI and ICI patients.

Conclusions: In conclusion, for non-squamous NSCLC patients, accepting PD-1 as the first-line treatment may be a relatively better option.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Forest plot of odds ratio or hazard ratios for ORR, PFS and OS in network meta-analysis.
Forest plots presenting ORR (a) odds ratio analysis and PFS (b) and OS (c) hazard ratio analysis. ICI immune checkpoint inhibitors, chemo-ICI ICI-combined chemotherapy.
Fig. 2
Fig. 2. Ranking probabilities base on the multiple comparisons on ORR, PFS and OS in network meta-analysis.
Ranking probabilities on ORR (a), PFS (b), and OS (c) in NSCLC patients with a high PD-L1 expression according to multiple comparisons. ICI immune checkpoint inhibitors, chemo-ICI ICI-combined chemotherapy.
Fig. 3
Fig. 3. Forest plot of odds ratio or hazard ratios for ORR, PFS and OS in the subgroup analysis.
Forest plots showing ORR (a1), PFS (b1) and OS (c1) hazard ratio analyses in the first-line treated group, ORR (a2), PFS (b2) and OS (c2) hazard ratio analyses in the previously treated group, ORR (a3), PFS (b3) and OS (c3) hazard ratio analyses in the PD-1 inhibitor group, ORR (a4), PFS (b4) and OS (c4) hazard ratio analyses in the PD-L1 inhibitor group, PFS (b5) and OS (c5) hazard ratio analyses in the non-squamous group and PFS (b6) and OS (c6) hazard ratio analyses in the squamous group. ICI immune checkpoint inhibitors, chemo-ICI ICI-combined chemotherapy.
Fig. 4
Fig. 4. Ranking probabilities base on the multiple comparisons on ORR, PFS and OS in the subgroup analysis.
Ranking probabilities based on the multiple comparisons on ORR (a1), PFS (b1) and OS (c1) in the first-line treated group, ORR (a2), PFS (b2) and OS (c2) in the previously treated group, ORR (a3), PFS (b3) and OS (c3) in the PD-1 inhibitor group, ORR (a4), PFS (b4) and OS (c4) in the PD-L1 inhibitor group, PFS (b5) and OS (c5) in the non-squamous group and PFS (b6) and OS (c6) in the squamous group. ICI immune checkpoint inhibitors, chemo-ICI ICI-combined chemotherapy.
See this image and copyright information in PMC

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