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

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...

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Published inJournal of clinical medicine Vol. 10; no. 7; p. 1365
Main Authors Majem, Margarita, Cobo, Manuel, Isla, Dolores, Marquez-Medina, Diego, Rodriguez-Abreu, Delvys, Casal-Rubio, Joaquín, Bueno, Teresa Moran, Bernabé-Caro, Reyes, Parente, Diego Pérez, Ruiz-Gracia, Pedro, Arroyo, Marta Marina, Paz-Ares, Luis
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Published Switzerland MDPI AG 26.03.2021
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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: HR = 0.69, 95% CI: 0.52-0.90, = 0.007), overall survival (OS: HR = 0.69, 95% CI: 0.61-0.78; < 0.001) and overall response rate (ORR) (Risk ratio (RR) = 1.354, 95% CI: 1.04-1.762, = 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.
AbstractList 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: HR = 0.69, 95% CI: 0.52-0.90, = 0.007), overall survival (OS: HR = 0.69, 95% CI: 0.61-0.78; < 0.001) and overall response rate (ORR) (Risk ratio (RR) = 1.354, 95% CI: 1.04-1.762, = 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.
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.
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: HR pooled = 0.69, 95% CI: 0.52–0.90, p = 0.007), overall survival (OS: HR pooled = 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.
Author Bueno, Teresa Moran
Marquez-Medina, Diego
Cobo, Manuel
Paz-Ares, Luis
Isla, Dolores
Arroyo, Marta Marina
Rodriguez-Abreu, Delvys
Ruiz-Gracia, Pedro
Majem, Margarita
Parente, Diego Pérez
Casal-Rubio, Joaquín
Bernabé-Caro, Reyes
AuthorAffiliation 6 Medical Oncology Service, Hospital Álvaro Cunqueiro, 36213 Vigo, Spain; joaquin.casal.rubio@sergas.es
9 Medical Affairs Department, Roche Farma S.A, 28042 Madrid, Spain; diego.perez@roche.com (D.P.-P.); pedro.ruiz.pr1@roche.com (P.R.-G.); marta.marina@contractors.roche.com (M.M.A.)
1 Medical Oncology, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
5 Medical Oncology, Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; delvysra@yahoo.com
10 Medical Oncology, Hospital 12 de Octubre, 28041 Madrid, Spain; lpazaresr@seom.org
8 Medical Oncology Department, Hospital Virgen del Rocío, 41013 Seville, Spain; reyesbernab@yahoo.es
3 Medical Oncology, University Hospital Clínico Lozano Blesa, Zaragoza, 50009 IIS Aragón, Spain; lola.isla@gmail.com
4 Medical Oncology, University Hospital Miguel Servet, 50009 Zaragoza, Spain; dmarmed@hotmail.com
2 Medical Oncology, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain; manuelcobodols@yahoo.es
7 Medi
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Keywords non-small cell lung cancer
PD-(L)1 inhibitors
first-line treatment
network meta-analysis
efficacy
immunotherapy
Language English
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Snippet 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...
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SubjectTerms Apoptosis
Biomarkers
Cancer therapies
Chemotherapy
Clinical medicine
Clinical trials
Immunotherapy
Lung cancer
Medical prognosis
Meta-analysis
Metastasis
Mutation
Oncology
Review
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Title 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
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https://pubmed.ncbi.nlm.nih.gov/PMC8036854
Volume 10
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