Efficacy and safety of immune checkpoint inhibitors combined with chemotherapy in patients with extensive-stage small cell lung cancer: a systematic review and meta-analysis of randomized controlled trials

Abstract

ObjectiveMany clinical trials of immune checkpoint inhibitors (ICIs) in combination with chemotherapy in the first-line treatment of extensive-stage small cell lung cancer (ES-SCLC) have been initiated, but the conclusions of these trials are not identical. This meta-analysis aimed to comprehensively collect these randomized clinical controlled trials (RCTs) to evaluate the efficacy and safety of ICIs combined with chemotherapy in the first-line treatment of ES-SCLC.MethodsWe systematically searched PubMed, Embase, and ClinicalTrials databases, to find relevant studies published until October 2022.RevMan 5.4 software was used for statistical analysis. The Cochrane Risk of Bias Tool was adopted to evaluate the risk of bias in the included studies. The primary outcome of this study was overall survival (OS), while the secondary outcomes were progression-free survival (PFS), objective response rate (ORR), all grand AEs (AEs), and ≥ 3 grand adverse events (≥ 3 AEs).ResultsA total of 780 articles were obtained in the initial examination, which was screened by layer and finally included 8 studies including 3367 patients. Six studies evaluated the efficacy of PD-1/PD-L1 inhibitors (Pembrolizumab, Nivolumab, Atezolizumab, Durvalumab, Adebrelimab, Serpulimab) combined with chemotherapy, and two studies evaluated the efficacy of CTLA-4 inhibitors (Ipilimumab) in combination with chemotherapy. The results showed that compared to chemotherapy alone, ICIs combined with chemotherapy significantly improved patients’ OS (HR=0.8, 95% CI (0.72-0.85), P<0.05), PFS (HR = 0.72, 95% CI (0.63-0.83), P < 0.05), and ORR(RR=1.08, 95% CI: 1.03-1.13, P<0.05), but patients would experience more any grand AEs and ≥3 grand AEs. Subgroup analysis showed that the PD-1/PD-L1 group performed better than the CTLA-4 group in both efficacy and safety. And ICIs plus chemotherapy significantly improved OS and PFS in patients regardless of age, gender, and performance status.ConclusionThe addition of ICIs to chemotherapy resulted in significant improvements in both PFS and OS for patients with ES-SCLC, but patients would experience more AEs.

Cost-effectiveness analysis of serplulimab combination therapy versus chemotherapy alone for patients with extensive-stage small cell lung cancer

“…The aforementioned studies have made significant contributions to the existing body of research on the cost-effectiveness analysis of diverse therapeutic approaches, thus offering valuable insights into the economic viability of ICIs as a treatment option for ES-SCLC. The economic implications of utilizing ICIs in combination with chemotherapy for ES-SCLC represent a crucial area of study, and the findings from these scholarly investigations shed light on the cost-effectiveness and feasibility of such treatment approaches (31). Further research is warranted to explore additional factors influencing the pharmacoeconomics of ES-SCLC treatments, taking into account various healthcare systems and cost thresholds.…”

Immune Checkpoint Inhibitors and Scleroderma: Data from the European Pharmacovigilance Database

“…Other researchers reported that the addition of ICIs to standard of care benefits a greater number of patients, prolonging survival with a manageable toxicity profile [ 5 ]. Data from a recent systematic review and meta-analysis highlighted that although the addition of ICIs to standard chemotherapy result in significant improvements in PFS and OS for patients with lung cancer, a worse safety profile can be expected [more adverse drug reactions (ADRs) observed] [ 6 ]. Finally, their efficacy was also demonstrated in the treatment of some rare tumors, such as Merkel cell carcinoma, squamous cell carcinoma of the skin, thymic epithelial tumors, and gestational trophoblastic neoplasia, as recently highlighted by Guven et al.…”