Comparative analysis of immune checkpoint inhibitors and chemotherapy in the treatment of advanced non-small cell lung cancer: A meta-analysis of randomized controlled trials.
Comparative analysis of immune checkpoint inhibitors and chemotherapy in the treatment of advanced non-small cell lung cancer: A meta-analysis of randomized controlled trials.
复制标题
免疫检查点抑制剂与化疗治疗晚期非小细胞肺癌的对比分析：随机对照试验的荟萃分析
DOI：
10.1097/md.0000000000011936
复制
发表时间：
2018-08
期刊：
影响因子：
1.6
通讯作者：
Yuan Y
中科院分区：
文献类型：
--
作者：
Khan M;Lin J;Liao G;Tian Y;Liang Y;Li R;Liu M;Yuan Y
补充数字内容在正文中可用最近，免疫检查点抑制剂在治疗晚期非小细胞肺癌(NSCLC)中显示出比化疗更好的生存优势。这项荟萃分析是为了收集和分析现有证据(证据水平I；随机对照试验)，比较抗程序性细胞死亡-1(PD1)/程序性细胞死亡配体-1(PD-L1)疗法和化疗治疗晚期非小细胞肺癌的疗效和安全性。设计了一种利用PubMed、Cochrane图书馆和Web of Science的电子数据库来识别随机对照试验(RCT)的搜索策略。采用固定效应模型或随机效应模型分析总生存期(OS)、无进展生存期(PFS)、客观应答率(ORR)和治疗相关不良事件(TRAE)的风险比或优势比。此外，还进行了亚组分析。共有7个随机对照试验(n = 3867)被确定和选择纳入这项荟萃分析。在晚期非小细胞肺癌中，抗pd1/pd-L1治疗(nivolumab、pembrolizumab、atezolizumab)的OS(HR 0.72[95%可信区间[CI]0.63，0.82；P <； .00001])、PFS(HR 0.84[95%CI 0.72，0.97；P <； .02])和ORR(优势比[OR]1.52[95%CI 1.08，2.14；P <； .02])明显优于化疗。抗PD1/PD-L1治疗的安全性得到改善(OR0.31[95%可信区间0.26，0.38；P <； .00001])。亚组分析显示东部合作肿瘤组表现状况(ECOG PS)1(HR 0.76[95%CI 0.62，0.93；P = .007])、鳞状细胞类型(HR 0.76[95%CI 0.63，0.92；P = .005])、现任/曾经吸烟者(HR 0.76[95%CI 0.63，0.92；P = .005])、表皮生长因子受体野生型(HR 0.67[95%CI 0.60，0.76；P <；KRAS基因突变(HR 0.60[95%CI 0.39，0.93；P <； .02])和无中枢神经系统转移(HR 0.71[95%CI 0.63，0.80；P <； .00001])与较好的总体生存率相关。抗PD1/PD-L1治疗晚期非小细胞肺癌安全有效，可选择性推荐。
Supplemental Digital Content is available in the text Recently, immune checkpoint inhibitors have shown survival advantage over chemotherapy in the treatment of advanced non-small cell lung cancer (NSCLC). This meta-analysis was conducted to gather and analyze the available evidence (Evidence level I; Randomized Controlled Trials) comparing efficacy and safety of anti-programmed cell death-1 (PD1)/programmed cell death ligand 1 (PD-L1) therapies and chemotherapy in the treatment of advanced NSCLC. A search strategy was devised to identify the randomized controlled trials (RCTs) using electronic databases of PubMed, Cochrane Library, and Web of Science. Hazard ratios or odds ratios obtained for overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and treatment related adverse events (TRAEs) were analyzed using fixed effect model or random effects model. Additionally, subgroup analysis was also performed. A total of seven RCTs (n = 3867) were identified and selected for inclusion in this meta-analysis. Anti-PD1/PD-L1 therapies (nivolumab, pembrolizumab, atezolizumab) resulted in better OS (HR 0.72 [95% confidence interval [CI] 0.63, 0.82; P < .00001]), PFS (HR 0.84 [95% CI 0.72, 0.97; P < .02]), and ORR (odds ratio [OR] 1.52 [95% CI 1.08, 2.14; P < .02]) in comparison to chemotherapy in advanced NSCLC. Improved safety was observed with anti-PD1/PD-L1 therapies (OR 0.31 [95%CI 0.26, 0.38; P < .00001]). Subgroups analysis revealed Eastern Cooperative Oncology Group Performance Status (ECOG PS) 1 (HR 0.76 [95%CI 0.62, 0.93; P = .007]), squamous cell type (HR 0.76 [95% CI 0.63, 0.92; P = .005]), current/former smoker (HR 0.76 [95% CI 0.63, 0.92; P = .005]), epidermal growth factor receptor (EGFR) wild type (HR 0.67 [95% CI 0.60, 0.76; P < .00001]), Kirsten rat sarcoma oncogene mutation (KRAS) mutant (HR 0.60 [95% CI 0.39, 0.93; P < .02]), and absence of central nervous system (CNS) metastases (HR 0.71 [95% CI 0.63, 0.80; P < .00001]) were associated with better overall survival. Anti-PD1/PD-L1 therapies are safe and effective treatment option in advanced non-small cell lung cancer and can be recommended selectively.