Key laboratory on Diagnosis and Treatment Technology on Thoracic Cancer, Zhejiang Cancer Hospital (Zhejiang Cancer Research Institute), Hangzhou, Zhejiang Province, 310022, China.
Department of Medical Oncology, Zhejiang Cancer Hospital, 38 Guangji Road, Hangzhou City, China.
Int J Cancer. 2018 Jun 1;142(11):2344-2354. doi: 10.1002/ijc.31252. Epub 2018 Jan 25.
Checkpoint inhibitors show promising efficacy in advanced lung cancer, especially in non-small-cell lung cancer (NSCLC). This meta-analysis was conducted to explore the therapeutic efficacy and safety of anti-PD-1/PD-L1 antibodies combined with chemotherapy or CTLA4 antibody as first-line treatments for patients with advanced lung cancer. A systematic search was performed in databases for this system review and quantitative meta-analysis. Twelve trials were finally enrolled in the meta-analysis. Our analyses revealed that the combined overall response rate (ORR) and disease control rate (DCR) for immune checkpoint inhibitors combined with chemotherapy for the treatment of NSCLC were 47.0% (95% CI: 34.2%-60.2%) and 80.9% (95% CI: 69.4%-88.7%), respectively. The combined ORR and DCR for CTLA4 antibody combined with chemotherapy for the treatment of small-cell lung cancer (SCLC) were 65.4% (61.1%-69.5%) and 87.6% (84.5%-90.2%), respectively. The combined six-month progression-free survival rates (PFSRs ) for NSCLC and SCLC were 50.2% (95% CI: 21.9%-78.4%) and 30.7% (21.2%-40.3%), respectively, and the OSRs were 56.4% (39.1%-73.7%) and 36.9% (33.3%-40.5%), respectively. In addition, the combined ORR and DCR for the checkpoint inhibitors plus CTLA4 antibody treatment group in NSCLC were 29.6% (95% CI: 11.4%-57.8%) and 48.7% (16.8%-81.7%), respectively. In subgroup analyses, a significant improvement in PFS was observed in NSCLC and SCLC, with a combined hazard ratio and 95% confidence interval of 0.841 (0.737-0.961) and 0.856 (0.756-0.968), respectively. In summary, synergistic activity and an acceptable safety profile were observed with checkpoint inhibitor plus chemotherapy combination treatment in lung cancer.
检查点抑制剂在晚期肺癌中显示出有希望的疗效，特别是在非小细胞肺癌（NSCLC）中。本荟萃分析旨在探讨抗 PD-1/PD-L1 抗体联合化疗或 CTLA4 抗体作为晚期肺癌患者一线治疗的疗效和安全性。对本系统评价和定量荟萃分析进行了系统检索。最终有 12 项试验纳入荟萃分析。我们的分析表明，免疫检查点抑制剂联合化疗治疗 NSCLC 的总缓解率（ORR）和疾病控制率（DCR）分别为 47.0%（95%CI：34.2%-60.2%）和 80.9%（95%CI：69.4%-88.7%）。CTLA4 抗体联合化疗治疗小细胞肺癌（SCLC）的 ORR 和 DCR 分别为 65.4%（61.1%-69.5%）和 87.6%（84.5%-90.2%）。NSCLC 和 SCLC 的联合 6 个月无进展生存率（PFSR）分别为 50.2%（95%CI：21.9%-78.4%）和 30.7%（21.2%-40.3%），OSR 分别为 56.4%（39.1%-73.7%）和 36.9%（33.3%-40.5%）。此外，NSCLC 中检查点抑制剂加 CTLA4 抗体治疗组的 ORR 和 DCR 分别为 29.6%（95%CI：11.4%-57.8%）和 48.7%（16.8%-81.7%）。亚组分析显示，在 NSCLC 和 SCLC 中，PFS 均有显著改善，联合风险比及其 95%置信区间分别为 0.841（0.737-0.961）和 0.856（0.756-0.968）。总之，在肺癌中，检查点抑制剂联合化疗联合治疗具有协同作用和可接受的安全性。
