Udayakumar Suji, Parmar Ambica, Leighl Natasha B, Everest Louis, Arciero Vanessa S, Santos Seanthel Delos, Rahmadian Amanda, Doherty Mark K, Chan Kelvin K W
Sunnybrook Research Institute, Toronto, ON, Canada.
Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada.
Crit Rev Oncol Hematol. 2022 May;173:103660. doi: 10.1016/j.critrevonc.2022.103660. Epub 2022 Mar 24.
Pembrolizumab monotherapy has replaced chemotherapy as first-line treatment for patients with metastatic non-small-cell lung cancer with tumor programmed death-ligand 1 expression ≥ 50%. The benefit of chemotherapy combined with pembrolizumab, as compared to pembrolizumab monotherapy, remains uncertain. This systematic review and network meta-analysis aimed to compare these therapies through a network of randomized controlled trials. Endpoints evaluated were progression-free survival (PFS) and overall survival (OS) expressed as hazard ratio (HR) and restricted mean survival time (RMST) through reconstruction of individual patient data from Kaplan-Meier curves, and objective response rate and adverse events. Four trials were included. Through HR and RMST, combination therapy demonstrated longer PFS and similar OS as compared to pembrolizumab monotherapy. Combination therapy was associated with an increase in response rate and adverse events. Thus, combination therapy can be considered when rapid response or prevention of rapid progression is needed. Further evidence to directly compare these therapies is required.
帕博利珠单抗单药治疗已取代化疗，成为肿瘤程序性死亡配体1表达≥50%的转移性非小细胞肺癌患者的一线治疗方法。与帕博利珠单抗单药治疗相比，化疗联合帕博利珠单抗的获益仍不确定。这项系统评价和网状Meta分析旨在通过随机对照试验网络比较这些治疗方法。评估的终点指标为无进展生存期（PFS）和总生存期（OS），通过从Kaplan-Meier曲线重建个体患者数据，以风险比（HR）和受限平均生存时间（RMST）表示，以及客观缓解率和不良事件。纳入了四项试验。通过HR和RMST，与帕博利珠单抗单药治疗相比，联合治疗显示出更长的PFS和相似的OS。联合治疗与缓解率增加和不良事件相关。因此，在需要快速缓解或预防快速进展时，可以考虑联合治疗。需要进一步的证据来直接比较这些治疗方法。
