Comparative efficacy of chemoimmunotherapy versus immunotherapy for advanced non–small cell lung cancer: A network meta-analysis of randomized trials
A partir d'une revue de la littérature (12 essais de phase III, 7 845 patients), cette méta-analyse compare l'efficacité, du point de vue de la survie globale, de la survie sans progression et du taux de réponse globale, des chimio-immunothérapies et des immunothérapies chez des patients atteints d'un cancer du poumon non à petites cellules de stade avancé, en fonction du statut tumoral de PD-L1
Background : To the authors' knowledge, in the absence of head-to-head trials, it is unclear whether chemoimmunotherapy provides an additional overall survival (OS) benefit compared with immunotherapy alone in the first-line treatment of patients with advanced non–small cell lung cancer (NSCLC). The authors conducted a systematic literature review and network meta-analysis (NMA) to compare the efficacy of chemoimmunotherapy versus ICI. Methods : MEDLINE, Excerpta Medica dataBASE (EMBASE), Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched from inception to April 2020. Phase 3 trials evaluating the efficacy of first-line ICI or chemoimmunotherapy and reporting efficacy outcomes (OS, progression-free survival [PFS], and the overall response rate [ORR]) stratified by programmed death–ligand 1 (PD-L1) status were included. NMA with a Bayesian random effects model was performed. Results : A total of 12 eligible trials comprising 7845 patients were included. In patients who were negative for PD-L1 (tumor proportion score [TPS] <1%), NMA comparing chemoimmunotherapy with dual-agent ICI failed to demonstrate a statistically significant difference with regard to OS, PFS, or the ORR. In patients with low PD-L1 (TPS 1%-49%), there was no statistically significant difference observed between chemoimmunotherapy compared with either single-agent ICI or dual-agent ICI with regard to OS or the ORR. In patients with high PD-L1 (TPS ≥50%), chemoimmunotherapy was found to be associated with an improved PFS and ORR compared with single-agent ICI, but not with dual-agent ICI. No differences in OS were observed with chemoimmunotherapy when compared with either single-agent or dual-agent ICIs. Conclusions : Although chemoimmunotherapy appears to improve the ORR and PFS in patients with PD-L1–high tumors when compared with single-agent ICI, it does not appear to confer an OS benefit over single-agent or dual-agent ICI for patients with advanced NSCLC regardless of PD-L1 status. Prospective trials are needed to validate these findings.
Cancer 2020