免疫检查点抑制剂治疗不同基因突变的非小细胞肺癌患者的疗效：一项荟萃分析。

Efficacy of immune checkpoint inhibitors in the treatment of non-small cell lung cancer patients with different genes mutation: A meta-analysis.

机构信息

Department of thoracic Oncology, JiLin Province Cancer Hospital, Changchun, JiLin, PR China.

出版信息

Medicine (Baltimore). 2021 Mar 12;100(10):e19713. doi: 10.1097/MD.0000000000019713.

BACKGROUND

Latest clinical trials have proved the better overall survival (OS) for the use of immune checkpoint inhibitors verse chemotherapy in non-small cell lung cancer (NSCLC) patients. However, we still have no clear ideas of the factors which could affect the efficacy of immune checkpoint inhibitors. Cancer, essentially, is a disease related to genes mutation. Therefore, we conducted a systematic review and meta-analysis to compare efficacy of immune checkpoint inhibitors for NSCLC patients with different genes mutation.

METHODS

PubMed, EMBASE, Web of Science, and the Cochrane Library databases were searched for all clinical trials in NSCLC until December 16, 2019. The hazard ratio (HR) and 95% confidence intervals (CIs) of OS or progression-free survival (PFS) were used.

RESULTS

A total of 4453 patients from 7 randomized controlled trials (RCTs) were included. Immune checkpoint inhibitors significantly prolonged the OS (HR, 0.67; 95% CI, 0.60-0.67) in NSCLC patients having epidermal growth factor receptor (EGFR) wild-type versus chemotherapy. Meanwhile, they prolonged the OS (HR, 0.61; 95% CI, 0.39-0.94) in NSCLC patients with Kirsten rat sarcoma viral oncogene homolog (KRAS) mutation. No matter PD-L1 tumor proportion scores were >1% or <1%, immune checkpoint inhibitors were more effective than chemotherapy (HR, 0.64; 95% CI, 0.55-0.75).

CONCLUSION

Immune checkpoint inhibitors are more efficacious than chemotherapy in NSCLC patients with EGFR wild-type, KRAS mutation, and any PD-L1 tumor proportion scores.

背景

最新的临床试验证明，在非小细胞肺癌（NSCLC）患者中，使用免疫检查点抑制剂比化疗具有更好的总生存期（OS）。然而，我们仍然不清楚哪些因素会影响免疫检查点抑制剂的疗效。癌症本质上是一种与基因突变相关的疾病。因此，我们进行了一项系统评价和荟萃分析，以比较不同基因突变的 NSCLC 患者使用免疫检查点抑制剂的疗效。

方法

检索PubMed、EMBASE、Web of Science 和 Cochrane Library 数据库，以获取截至 2019 年 12 月 16 日所有 NSCLC 的临床试验。使用 OS 或无进展生存期（PFS）的风险比（HR）和 95%置信区间（CI）。

结果

共有来自 7 项随机对照试验（RCTs）的 4453 名患者纳入研究。与化疗相比，免疫检查点抑制剂在表皮生长因子受体（EGFR）野生型 NSCLC 患者中显著延长 OS（HR，0.67；95%CI，0.60-0.67）。同时，它们在 NSCLC 患者中延长了 KRAS 突变患者的 OS（HR，0.61；95%CI，0.39-0.94）。无论 PD-L1 肿瘤比例评分>1%还是<1%，免疫检查点抑制剂均比化疗更有效（HR，0.64；95%CI，0.55-0.75）。