Comparative Efficacy and Safety of Immunotherapy on Non–Small Cell Lung Cancer Patients With Brain Metastases: A Systematic Review and Network Meta‐Analysis

• Published in: The clinical respiratory journal Vol. 18; no. 8; pp. e13823 - n/a
• Main Authors: Lyu, Tianyi, Sun, Bo, Yang, Daowen, Zhao, Xirui, Wang, Ruoshui, Shu, Xinyang, Li, Demin, Chen, Hong
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01.08.2024; John Wiley and Sons Inc; Wiley
• Subjects: Antibodies, Monoclonal, Humanized - adverse effects; Antibodies, Monoclonal, Humanized - therapeutic use; Antineoplastic Agents, Immunological - adverse effects; Antineoplastic Agents, Immunological - therapeutic use; brain neoplasms; Brain Neoplasms - secondary; Brain Neoplasms - therapy; carcinoma; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - secondary; Carcinoma, Non-Small-Cell Lung - therapy; Humans; Immunotherapy; Immunotherapy - adverse effects; Immunotherapy - methods; Ipilimumab - administration & dosage; Ipilimumab - adverse effects; Ipilimumab - therapeutic use; Lung cancer; Lung Neoplasms - drug therapy; Lung Neoplasms - pathology; Lung Neoplasms - therapy; Metastasis; Network Meta-Analysis; Nivolumab - adverse effects; Nivolumab - therapeutic use; non–small cell lung; Review; Treatment Outcome; non–small cell lung; brain neoplasms; network meta‐analysis; carcinoma; immunotherapy
• ISSN: 1752-6981; 1752-699X; 1752-699X
• DOI: 10.1111/crj.13823

ABSTRACT Background Growing evidence suggests that immunotherapy has a positive effect on non–small cell lung cancer (NSCLC) patients with brain metastases (BMs). However, it remains unclear which type of immunotherapy is more efficient. The aim of this network meta‐analysis (NMA) was to compare the efficacy and safety of different immunotherapy types and determine the optimal option. Method Four databases (PubMed, Cochrane Library databases, Embase, and Web of Science) and ClinicalTrial.gov were searched from inception until January 26, 2023. Randomized controlled trials (RCTs), prospective nonrandomized trials, or observational studies investigating NSCLC patients with BMs treated by immunotherapy were included. The quality of the included studies was evaluated using the Cochrane risk of bias (ROB) tool and the Newcastle‐Ottawa Scale (NOS). The efficacy of immunotherapy on NSCLC patients with BMs was evaluated using frequentist random‐effects NMA. Result Eleven studies from 1560 citations, encompassing 1437 participants, were included in this NMA. Statistical analysis showed that pembrolizumab (SMD = 4.35, 95% CI [2.21, 6.60]) and nivolumab+ipilimumab (SMD = 3.81, 95% CI [1.21, 6.40]) could improve overall survival (OS). Pembrolizumab (SMD = 3.32, 95% CI [2.75, 3.90]) demonstrated better effects in improving the overall response rate (ORR). No significant difference in adverse event (AE) was observed between immunotherapy and chemotherapy. Conclusion Our findings indicated that pembrolizumab was the most promising immunotherapy for NSCLC patients with BMs. Nivolumab+ipilimumab might be an alternative choice to improve OS. Limitation Inconsistency tests were not performed because of the scarcity of direct comparison. Besides, high heterogeneity was observed in our NMA. NMA was conducted to compare the efficacy and safety of different immunotherapy types on NSCLC patients with BMs. Our findings indicated that pembrolizumab was the most promising immunotherapy.