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

Wang, Yimin; Han, Hedong; Zhang, Fang; Lv, Tangfeng; Zhan, Ping; Ye, Mingxiang; Song, Yong; Liu, Hongbing

doi:10.1038/s41416-022-01832-4

Cited by 28 publications

(23 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We used the ASCO and ESMO clinical benefit frameworks to guide our interpretation of whether changes in survival were clinically meaningful. In a secondary analysis, we evaluated patterns of ICI use with and without concomitant chemotherapy because evidence has suggested superiority of ICIs in combination with chemotherapy in some settings …”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Association Between Age and Survival Trends in Advanced Non–Small Cell Lung Cancer After Adoption of Immunotherapy

et al. 2023

View full text Add to dashboard Cite

ImportanceThe introduction of immune checkpoint inhibitors (ICIs) has transformed the care of advanced non–small cell lung cancer (NSCLC). Although clinical trials suggest substantial survival benefits, it is unclear how outcomes have changed in clinical practice.ObjectiveTo assess temporal trends in ICI use and survival among patients with advanced NSCLC across age strata.Design, Setting, and ParticipantsThis cohort study was performed in approximately 280 predominantly community-based US cancer clinics and included patients aged 18 years or older who had stage IIIB, IIIC, or IV NSCLC diagnosed between January 1, 2011, and December 31, 2019, with follow-up through December 31, 2020. Data were analyzed April 1, 2021, to October 19, 2022.Main Outcomes and MeasuresMedian overall survival and 2-year survival probability. The predicted probability of 2-year survival was calculated using a mixed-effects logit model adjusting for demographic and clinical characteristics.ResultsThe study sample included 53 719 patients (mean [SD] age, 68.5 [9.3] years; 28 374 men [52.8%]), the majority of whom were White individuals (36 316 [67.6%]). The overall receipt of cancer-directed therapy increased from 69.0% in 2011 to 77.2% in 2019. After the first US Food and Drug Administration approval of an ICI for NSCLC, the use of ICIs increased from 4.7% in 2015 to 45.6% in 2019 (P &lt; .001). Use of ICIs in 2019 was similar between the youngest and oldest patients (aged &lt;55 years, 45.2% vs aged ≥75 years, 43.8%; P = .59). From 2011 to 2018, the predicted probability of 2-year survival increased from 37.7% to 50.3% among patients younger than 55 years and from 30.6% to 36.2% in patients 75 years or older (P &lt; .001). Similarly, median survival in patients younger than 55 years increased from 11.5 months to 16.0 months during the study period, while survival among patients 75 years or older increased from 9.1 months in 2011 to 10.2 months in 2019.Conclusions and RelevanceThis cohort study found that, among patients with advanced NSCLC, the uptake of ICIs after US Food and Drug Administration approval was rapid across all age groups. However, corresponding survival gains were modest, particularly in the oldest patients.

show abstract

Section: Introductionmentioning

confidence: 99%

“…In a secondary analysis, we evaluated patterns of ICI use with and without concomitant chemotherapy because evidence has suggested superiority of ICIs in combination with chemotherapy in some settings. [24][25][26][27][28]…”

mentioning

confidence: 99%

Association Between Age and Survival Trends in Advanced Non–Small Cell Lung Cancer After Adoption of Immunotherapy

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Studies show when immunotherapies are included in treatment regimens, patients with NSCLC experience prolonged overall survival and more patients achieve complete responses [13, 14]. Additionally, therapies which are targeted at specific genetic mutations are leading to longer progression-free survival [6, 15, 16]. With more durable and targeted therapeutic regimens, a patient’s second primary lung cancer is given more time and thus more opportunity to grow, to mutate, and to unmask itself.…”

Section: Discussionmentioning

confidence: 99%

Synchronous Primary Lung Cancers Containing Discrete Driver Mutations in a Never-Smoker: Case Report

Davis,

Jarrar,

Ciunci

2023

Case Rep Oncol

View full text Add to dashboard Cite

Although most lung cancer patients present with one primary cancer, some present with multiple lung cancers of different clonal origin. Timely recognition of synchronous multifocal primary lung cancer (MPLC) enables distinct treatment regimens that reflect the unique genotypic makeup and location of each cancer. However, recognition of synchronous MPLCs is challenging given the prevalence of multifocal disease. Here, we report a case of a patient diagnosed with anaplastic lymphoma kinase, termed ALK, positive metastatic lung adenocarcinoma whose follow-up computerized tomography (CT) imaging identified one lesion, present since the patient’s initial presentation, with a distinctly different response to treatment than other lesions. Biopsy results showed a distinct MPLC, an epidermal growth factor receptor (EGFR)-positive adenocarcinoma with no evidence of an ALK mutation. The EGFR lesion was treated with curative intent via surgical resection while the ALK disease was managed with palliative intent via targeted therapy. To our knowledge, there have been no other reports of two synchronous MPLCs of an adenocarcinoma subtype with completely distinct EGFR and ALK driver mutations. This case highlights the importance of serial follow-up imaging, combined with biopsy of lesions with atypical treatment responses, as a method for identifying synchronous MPLCs and adjusting treatment to optimize patient outcomes.

show abstract

“…Several published NMAs have considered populations with different levels of PD-L1 expression l as potential subgroups ( 16 , 53 , 57 , 62 ). For example, Liu et al ( 16 ) reported that the greatest OS was achieved by niv + ipi + che in patients with PD-L1 expression< 1% and by pem + che in patients with PD-L1 expression ≥ 1%.…”

Section: Discussionmentioning

confidence: 99%

“…For example, Liu et al ( 16 ) reported that the greatest OS was achieved by niv + ipi + che in patients with PD-L1 expression< 1% and by pem + che in patients with PD-L1 expression ≥ 1%. Sheng et al ( 53 ) and Wang et al ( 62 ) found that, among nsq-NSCLC patients with high PD-L1 expression, ICI combination therapies were associated with significantly greater OS and PFS benefits than ICI-free therapies, but significant PFS benefits only when compared with ICIs alone therapy ( 53 , 62 ). However, Passiglia et al ( 57 ) found that ICI combinations had limited effects in patients with high PD-L1 expression, but might be a suitable option for the subgroup who are PD-L1 negative.…”

Section: Discussionmentioning

confidence: 99%

A systematic review and network meta-analysis of first-line immune checkpoint inhibitor combination therapies in patients with advanced non-squamous non-small cell lung cancer

et al. 2022

View full text Add to dashboard Cite

IntroductionClinical evidence suggests that first-line immune checkpoint inhibitor (ICI) combination therapies can improve survival in patients with advanced non-squamous non-small cell lung cancer (nsq-NSCLC). However, the optimal strategy remains unknown without a systematic comparison of their long-term effects.MethodsWe performed a systematic review and network meta-analysis by retrieving up-to-date literature from PubMed® (National Library of Medicine, Bethesda, MD, USA), Embase® (Elsevier, Amsterdam, Netherlands), MEDLINE® (National Library of Medicine), ClinicalTrials.gov (National Library of Medicine), and major international conference publications. Published studies and abstracts comparing first-line ICI combination therapies with other treatments for patients with advanced nsq-NSCLC were included. Restricted mean survival time (RMST) was measured over 12 months for progression-free survival (PFS) and 18 months for overall survival (OS), and the Royston–Parmar model was used to extrapolate and compare data for the long-term outcomes.ResultsWe included a total of 11 trials involving 12 therapies and 6,130 patients. Pembrolizumab plus chemotherapy exhibited the best overall survival (OS) benefit at both 18 and 60 months [RMST = 2.95, 95% confidence interval (CI) 1.96 to 3.97; life-years gained over a 5-year period = 2.18 years]. Nivolumab plus bevacizumab plus chemotherapy was found to present the best progression-free survival (PFS) benefit at 12 months (RMST 3.02, 95% CI 2.11 to 3.91), whereas atezolizumab plus bevacizumab plus chemotherapy showed the best PFS benefit at 36 months (life-years gained over 3 years = 1.22 years). Subgroup analyses showed that among patients with programmed death-ligand 1 (PD-L1) expression ≥ 50%, atezolizumab plus chemotherapy and nivolumab plus ipilimumab resulted in superior OS benefits at 18 and 60 months, respectively. Among patients with PD-L1 expression< 1%, pembrolizumab plus chemotherapy was associated with OS benefits at both 18 and 60 months. Sintilimab plus chemotherapy was associated with relatively fewer grade ≥ 3 adverse events than other ICI combination therapies.ConclusionOur results show that ICI combination therapies showed better survival benefits than chemotherapy. Pembrolizumab plus chemotherapy could provide the best OS benefits to patients with advanced nsq-NSCLC, whereas atezolizumab plus bevacizumab plus chemotherapy could bring the best PFS benefits. The optimal ICI combination therapy varies depending on PD-L1 expression level.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=325005, identifier CRD42022325005.

show abstract

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

Cited by 28 publications

References 30 publications

Association Between Age and Survival Trends in Advanced Non–Small Cell Lung Cancer After Adoption of Immunotherapy

Association Between Age and Survival Trends in Advanced Non–Small Cell Lung Cancer After Adoption of Immunotherapy

Synchronous Primary Lung Cancers Containing Discrete Driver Mutations in a Never-Smoker: Case Report

A systematic review and network meta-analysis of first-line immune checkpoint inhibitor combination therapies in patients with advanced non-squamous non-small cell lung cancer

Contact Info

Product

Resources

About