Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Dis Markers. 2022 Aug 26;2022:2631852. doi: 10.1155/2022/2631852. eCollection 2022.
To assess and compare the effectiveness of immune checkpoint inhibitors vs. chemotherapy for KRAS-mutant or EGFR-mutant non-small-cell lung cancers.
Until February 19, 2022, Cochrane Library, PubMed, Web of Science, and Embase were searched for relevant randomized controlled trials (RCTs) in NSCLC. Progression-free survival (PFS) and overall survival (OS) were used as outcome measures. The studies were conducted using the Cochrane methodology for meta-analyses, and all statistical analyses were made with Review Manager Software (RevMan version 5.4).
Our meta-analysis included nine clinical trials including 5633 participants with NSCLC. Immune checkpoint drugs extended OS (hazard ratio (HR), 0.67; 95% confidence interval (CI), 0.60-0.76) and PFS (HR, 0.44; 95% CI, 0.35-0.56) in patients with EGFR wild-type compared to chemotherapy alone, whereas programmed cell death 1 ligand 1 (PD-L1)/programmed cell death-1 (PD-1) inhibitors with chemotherapy versus chemotherapy extended PFS in NSCLC patients with EGFR mutations (HR, 0.63; 95% CI, 0.42-0.94). Meanwhile, immune checkpoint inhibitors vs. chemotherapy improved the OS (HR, 0.65; 95% CI, 0.48-0.88) and PFS (HR, 0.49; 95% CI, 0.36-0.66) of NSCLC patients with KRAS mutation. NSCLCs with KRAS G12C mutation had a much better PFS with ICIs than with chemotherapy (HR, 0.38; 95% CI, 0.21-0.71).
This research revealed that individuals with EGFR wild-type NSCLC or KRAS mutation may benefit from PD-L1/PD-1 inhibitors and that PD-L1/PD-1 inhibitors in combination with chemotherapy seem to be more successful than chemotherapy alone in NSCLC patients with EGFR mutation.
评估和比较免疫检查点抑制剂与化疗在治疗 KRAS 突变或 EGFR 突变非小细胞肺癌中的疗效。
截至 2022 年 2 月 19 日，检索 Cochrane 图书馆、PubMed、Web of Science 和 Embase 中关于非小细胞肺癌的相关随机对照试验（RCT）。无进展生存期（PFS）和总生存期（OS）用作结局指标。研究采用 Cochrane 方法进行荟萃分析，所有统计分析均使用 Review Manager Software（RevMan 版本 5.4）进行。
我们的荟萃分析纳入了 9 项临床试验，共纳入 5633 例非小细胞肺癌患者。与单纯化疗相比，免疫检查点药物延长了 EGFR 野生型患者的 OS（风险比（HR），0.67；95%置信区间（CI），0.60-0.76）和 PFS（HR，0.44；95%CI，0.35-0.56），而 PD-L1/PD-1 抑制剂联合化疗与化疗相比，延长了 EGFR 突变的非小细胞肺癌患者的 PFS（HR，0.63；95%CI，0.42-0.94）。同时，免疫检查点抑制剂与化疗相比，改善了 KRAS 突变的非小细胞肺癌患者的 OS（HR，0.65；95%CI，0.48-0.88）和 PFS（HR，0.49；95%CI，0.36-0.66）。KRAS G12C 突变的非小细胞肺癌患者使用 ICIs 的 PFS 明显优于化疗（HR，0.38；95%CI，0.21-0.71）。
这项研究表明，EGFR 野生型非小细胞肺癌或 KRAS 突变患者可能受益于 PD-L1/PD-1 抑制剂，PD-L1/PD-1 抑制剂联合化疗似乎比 EGFR 突变的非小细胞肺癌患者单纯化疗更有效。
