Radiotherapy Department, The Third Affiliated Hospital of Guangxi Medical University, Nanning 530000, Guangxi, China.
Radiotherapy Department, The Third Affiliated Hospital of Guangxi Medical University, Nanning 530000, Guangxi, China.
Int Immunopharmacol. 2021 Jul;96:107594. doi: 10.1016/j.intimp.2021.107594. Epub 2021 Mar 30.
Combination therapies with immune checkpoint blockade demonstrate promising antitumor activity and safety in Non-small Cell Lung Cancer (NSCLC). However, whether the combination therapy is superior to their monotherapies, and which combination regimen is most efficacious remain unknown. This meta-analysis aims to synthesize the current available evidences on the efficacy and safety of combination immunotherapy in patients with NSCLC.
PubMed, Embase and Cochrane Library were searched. Randomized controlled trials (RCTs) investigating combination therapy with immune checkpoint inhibitors in NSCLC were included.
We identified nine RCTs including a total of 5,142 patients. The study showed that the pooled hazard ratios (HRs) of overall survival (OS) and progression-free survival (PFS) for combination therapy were 0.74 (95% CI: 0.63-0.86, p = 0.001) and 0.65 (95% CI: 0.56-0.73, p = 0.004); the pooled odds ratios (ORs) of objective response rates (ORRs) and grade 3 or higher adverse events (AEs) were 1.51 (95% CI: 1.02-1.99, p < 0.001) and 1.30 (95% CI: 1.03-1.57, p = 0.007). Subgroup analysis showed that the OR of grade 3 or higher AEs for immunotherapy plus chemotherapy was higher than that of chemotherapy alone, but did not reach statistical significance (p = 0.061) , and there was PFS and OS benefit for either immunotherapy plus chemotherapy, double agent immunotherapy or immunotherapy plus targeted plus chemotherapy combination regimens.
Combination therapy with immune checkpoint inhibitors showed more clinical benefit for patients with NSCLC, with increased grade 3 or higher AEs, but toxicities were manageable.
免疫检查点阻断联合治疗在非小细胞肺癌（NSCLC）中显示出有前景的抗肿瘤活性和安全性。然而，联合治疗是否优于其单药治疗，以及哪种联合方案最有效仍不清楚。本荟萃分析旨在综合目前关于 NSCLC 患者联合免疫治疗的疗效和安全性的现有证据。
检索 PubMed、Embase 和 Cochrane Library。纳入研究免疫检查点抑制剂联合治疗 NSCLC 的随机对照试验（RCT）。
我们确定了 9 项 RCT，共纳入 5142 名患者。研究表明，联合治疗的总生存（OS）和无进展生存（PFS）的合并风险比（HR）分别为 0.74（95%CI：0.63-0.86，p=0.001）和 0.65（95%CI：0.56-0.73，p=0.004）；客观缓解率（ORR）和 3 级或更高不良事件（AE）的合并优势比（OR）分别为 1.51（95%CI：1.02-1.99，p<0.001）和 1.30（95%CI：1.03-1.57，p=0.007）。亚组分析表明，免疫治疗加化疗的 3 级或更高 AE 的 OR 高于单独化疗，但未达到统计学意义（p=0.061），免疫治疗加化疗、双药免疫治疗或免疫治疗加靶向加化疗联合方案均有 PFS 和 OS 获益。
免疫检查点抑制剂联合治疗为 NSCLC 患者带来了更多的临床获益，同时增加了 3 级或更高的 AE，但毒性是可控的。
