PD-(L)1 Inhibitors as Monotherapy for the First-Line Treatment of Non-Small-Cell Lung Cancer Patients with High PD-L1 Expression: A Network Meta-Analysis
Por:
Majem, M, Cobo, M, Isla, D, Marquez-Medina, D, Rodriguez-Abreu, D, Casal-Rubio, J, Moran-Bueno, T, Bernabe-Caro, R, Perez-Parente, D, Ruiz-Gracia, P, Arroyo, MM, Paz-Ares, L
Publicada:
1 abr 2021
Resumen:
Programmed cell death-ligand 1 (PD-L1) has emerged as a potential biomarker for selection of patients more likely to respond to immunotherapy and as a prognostic factor in non-small cell lung cancer (NSCLC). In this network meta-analysis, we aimed to evaluate the efficacy of first-line anti-PD-(L)1 monotherapy in advanced NSCLC patients with high PD-L1 expression (>= 50%) compared to platinum-based chemotherapy. We also evaluated efficacy outcomes according to tumor mutational burden (TMB). To that end, we conducted a systematic review. Six clinical trials with 2111 patients were included. In head-to-head comparisons, immunotherapy showed a significant improvement in progression-free survival (PFS: HRpooled = 0.69, 95% CI: 0.52-0.90, p = 0.007), overall survival (OS: HRpooled = 0.69, 95% CI: 0.61-0.78; p < 0.001) and overall response rate (ORR) (Risk ratio (RR)(pooled) = 1.354, 95% CI: 1.04-1.762, p = 0.024). In the assessment of relative efficacy for PFS through indirect comparisons, pembrolizumab (results from KEYNOTE-024) ranked highest followed by cemiplimab and atezolizumab, with statistical significance determined for some of the drugs. In terms of OS, cemiplimab ranked highest followed by atezolizumab and pembrolizumab, although non-significant OS was determined for these drugs. In conclusion, PD-(L)1 inhibitor monotherapy improves efficacy outcomes in the first line setting of advanced NSCLC patients with high PD-L1 expression. Evaluations with longer follow up are still needed to determine the superiority of any specific drug.
Filiaciones:
Majem, M:
Hosp Santa Creu & Sant Pau, Med Oncol, Barcelona 08041, Spain
Cobo, M:
Hosp Reg Univ Malaga, Med Oncol, Malaga 29010, Spain
Isla, D:
Univ Hosp Clin Lozano Blesa, Med Oncol, IIS Aragon, Zaragoza 50009, Spain
Marquez-Medina, D:
Univ Hosp Miguel Servet, Med Oncol, Zaragoza 50009, Spain
Rodriguez-Abreu, D:
Hosp Univ Insular Gran Canaria, Med Oncol, Las Palmas Gran Canaria 35016, Spain
Casal-Rubio, J:
Hosp Alvaro Cunqueiro, Med Oncol Serv, Vigo 36213, Spain
Moran-Bueno, T:
Hosp Badalona Germans Trias & Pujol, Med Oncol, Badalona 08916, Spain
Bernabe-Caro, R:
Hosp Virgen Rocio, Med Oncol Dept, Seville 41013, Spain
Perez-Parente, D:
Roche Farma SA, Med Affairs Dept, Madrid 28042, Spain
Ruiz-Gracia, P:
Roche Farma SA, Med Affairs Dept, Madrid 28042, Spain
Arroyo, MM:
Roche Farma SA, Med Affairs Dept, Madrid 28042, Spain
Paz-Ares, L:
Hosp 12 Octubre, Med Oncol, Madrid 28041, Spain
gold, Green Published
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