Quality of life in patients with non-small cell lung cancer treated with PD-1/PD-L1 inhibitors: a systematic review and meta-analysis

Abstract

Background Immune checkpoint inhibitors (ICIs) have dramatically prolonged survival in non-small cell lung cancer (NSCLC) patients, but little research had focused on its impact on quality of life (QoL). The purpose of our study was to compare the QoL in patients with NSCLC treated with programmed cell death protein-1/programmed cell death-ligand 1 (PD-1/PD-L1) inhibitors versus chemotherapy. Methods We searched for randomized controlled trials utilizing the Quality of Life Questionnaire Core 30 items (QLQ-C30) and the EuroQol Five Dimensions Questionnaire-3L (EQ-5D-3L) to assess the QoL of NSCLC treated with PD-1/PD-L1 inhibitors versus chemotherapy. We collected hazard ratios (HRs) for the time from baseline to the first clinically significant deterioration (TTD) and effect size as the difference in mean change between and within treatment groups in patients’ reported outcomes (PROs). (PROSPERO registration number: CRD42022296680). Results In the five trials reported by QLQ-C30, TTD was longer in PD-1/PD-L1 inhibitors compared with control groups (HR = 0.86; 95% CI = 0.76, 0.97; P = 0.013), with similar results in terms of physical function, role function, and pain. The difference in mean change between the PD-1/PD-L1 inhibitors group and the chemotherapy group in QLQ-C30 and EQ-5D VAS was 3.64 (95% CI = 1.62, 5.66; P = 0.001) and 4.74 (95% CI = 2.65, 6.83; P = 0.001), which supported PD-1/PD-L1 inhibitors. However, for the EQ-5D utility index, there was no statistically significant difference between the two groups, with a mean change difference of 0.03 (95% CI = −0.01, 0.07; P = 0.094). The mean change from baseline to follow-up in PD-1/PD-L1 inhibitors group was 2.57 (95% CI = 0.43, 4.71; P = 0.019), and chemotherapy group was −1.31 (95% CI = −3.71, 1.09; P = 0.284), correspondingly. The subgroup analysis showed that no difference was observed between open-label and double-blind trials in patients treated with chemotherapy or PD-1/PD-L1 inhibitors. Conclusion In conclusion, PD-1/PD-L1 inhibitors could improve the QoL of patients with NSCLC compared to chemotherapy and reduce unfavorable symptoms during treatment.

Effects of Immunotherapy on Quality-of-Life Outcomes in Patients with Gastroesophageal Cancers: A Meta-Analysis of Randomized Controlled Trials

“…For example, ICIs primarily target speci c immune checkpoints, resulting in fewer direct cytotoxic effects on healthy cells and organs and potentially leading to reduced pain levels [33]. Aligning with our ndings, a meta-analysis of ve RCTs found that PD-1/PD-L1 inhibitors led to longer times to rst clinically signi cant deterioration in HRQoL scores, as well as improvements in physical function and pain in patients with lung cancer [34]. A recent subgroup analysis of the CheckMate 649 trial showed more signi cant improvements in the FACT-Ga total, GaCS, and EQ-5D visual analog scale in patients receiving a combination of ICIs and chemotherapy than in patients receiving chemotherapy, with a reduction in HRQoL deterioration [35].…”

T cell proliferation-related subtypes, prognosis model and characterization of tumor microenvironment in head and neck squamous cell carcinoma

“…Cancer immunotherapy strategies include ICIs, adoptive cell therapy, monoclonal antibodies, oncolytic virus immunotherapy, and vaccination [49]. ICIs are progressing rapidly, and have recently brought new light to the treatment of HNSC [50]. In conclusion, low-risk patients are more likely to bene t from immunotherapy.…”

Health Outcomes with Curative and Palliative Therapies in Real World: Role of the Quality of Life Summary Score in Thoracic Oncology Patients

“…In addition, we lumped together different therapeutic strategies into only a curative and palliative group. Although this makes sense from the patient's viewpoint, one should be aware that the obtained results would benefit from a more in-depth analysis-e.g., when comparing the effects of targeted therapy vs. immunotherapy vs. chemotherapy [32,46,47] or for surgery vs. radiation therapy [48]. In a recent review, it was shown that across most studies, QOL remained stable after treatment with stereotactic radiation therapy, but not after surgery [48].…”