The Emergency Department, 74784Zhuji People's Hospital, Shaoxing, China.
The First Clinical Medical College, 70571Zhejiang Chinese Medical University, Hangzhou, China.
Cancer Control. 2022 Jan-Dec;29:10732748221107590. doi: 10.1177/10732748221107590.
With the use of immune-checkpoint inhibitors (ICIs) in advanced or metastatic non-small cell lung cancer (NSCLC), whether ICIs or chemotherapy is more effective still remains controversial. This study was conducted to evaluate the efficacy of programmed cell death 1 (PD-1), programmed cell death ligand 1 (PD-L1), cytotoxic T-lymphocyte protein 4 (CTLA-4) alone or in their combination vs chemotherapy in patients with advanced or metastatic NSCLC.
This meta-analysis was conducted from PubMed, Web of Science, Medline, Embase, and the Cochrane Library up to March 2021 to identify relevant randomized controlled trials. Primary endpoints were overall survival (OS) and progression-free survival (PFS). Secondary endpoint was adverse events (AEs). This meta-analysis's Prospero registration number is CRD42022323570.
The search process has identified 13 studies containing 7918 patients with advanced or metastatic NSCLC. The benefit of PD-1/L1 or CTLA-4 inhibitors alone or in combination compared with chemotherapy for advanced or metastatic NSCLC was elucidated in both OS [HR = .75, 95% CI (.70-.80), < .001] and PFS [HR = .83, 95% CI (.73-.95), < .001]. Besides, ICIs were associated with fewer AEs compared to chemotherapy.
PD-1/L1 or CTLA-4 inhibitors alone or in combination, with fewer AEs, was associated with significant improvements in terms of OS and PFS than chemotherapy in advanced or metastatic NSCLC.
免疫检查点抑制剂（ICIs）在晚期或转移性非小细胞肺癌（NSCLC）中的应用，ICI 与化疗相比哪种更有效仍存在争议。本研究旨在评估程序性死亡受体 1（PD-1）、程序性死亡配体 1（PD-L1）、细胞毒性 T 淋巴细胞相关蛋白 4（CTLA-4）单药或联合化疗治疗晚期或转移性 NSCLC 的疗效。
本荟萃分析检索了 PubMed、Web of Science、Medline、Embase 和 Cochrane Library 自 2021 年 3 月以来的相关随机对照试验，主要终点为总生存期（OS）和无进展生存期（PFS），次要终点为不良反应（AEs）。本荟萃分析的 PROSPERO 注册号为 CRD42022323570。
检索过程共确定了 13 项包含 7918 例晚期或转移性 NSCLC 患者的研究。结果表明，与化疗相比，PD-1/L1 或 CTLA-4 抑制剂单药或联合治疗晚期或转移性 NSCLC 在 OS [HR=0.75，95%CI（0.70-0.80），<0.001]和 PFS [HR=0.83，95%CI（0.73-0.95），<0.001]方面均有获益。此外，ICI 与化疗相比，不良反应更少。
PD-1/L1 或 CTLA-4 抑制剂单药或联合应用，不良反应更少，与化疗相比，可显著改善晚期或转移性 NSCLC 的 OS 和 PFS。
