1
|
Majem M, Cobo M, Isla D, Marquez-Medina D, Rodriguez-Abreu D, Casal-Rubio J, Moran-Bueno T, Bernabé-Caro R, Pérez-Parente D, Ruiz-Gracia P, Arroyo MM, Paz-Ares L. 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. J Clin Med 2021; 10:1365. [PMID: 33810441 PMCID: PMC8036854 DOI: 10.3390/jcm10071365] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/18/2021] [Accepted: 03/21/2021] [Indexed: 12/24/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Margarita Majem
- Medical Oncology, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
| | - Manuel Cobo
- Medical Oncology, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain;
| | - Dolores Isla
- Medical Oncology, University Hospital Clínico Lozano Blesa, Zaragoza, 50009 IIS Aragón, Spain;
| | | | - Delvys Rodriguez-Abreu
- Medical Oncology, Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain;
| | | | - Teresa Moran-Bueno
- Medical Oncology, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain;
| | - Reyes Bernabé-Caro
- Medical Oncology Department, Hospital Virgen del Rocío, 41013 Seville, Spain;
| | - Diego Pérez-Parente
- Medical Affairs Department, Roche Farma S.A, 28042 Madrid, Spain; (D.P.-P.); (P.R.-G.); (M.M.A.)
| | - Pedro Ruiz-Gracia
- Medical Affairs Department, Roche Farma S.A, 28042 Madrid, Spain; (D.P.-P.); (P.R.-G.); (M.M.A.)
| | - Marta Marina Arroyo
- Medical Affairs Department, Roche Farma S.A, 28042 Madrid, Spain; (D.P.-P.); (P.R.-G.); (M.M.A.)
| | - Luis Paz-Ares
- Medical Oncology, Hospital 12 de Octubre, 28041 Madrid, Spain;
| |
Collapse
|