Shen Min, Lu Chunxia, Gao Jie
Department of Respiratory and critical care, Qidong People's Hospital/Qidong Liver Cancer Institute/Affiliated Qidong Hospital of Nantong University, Qidong, China.
Front Oncol. 2023 Apr 19;13:1137913. doi: 10.3389/fonc.2023.1137913. eCollection 2023.
Lung cancer is a common malignant tumor, which is seriously harmful to human life and health. Nowadays, it has gradually become one of the best treatments for non-small cell lung cancer (NSCLC) to combine immunotherapy and chemotherapy, and its clinical efficacy is preliminary. Nevertheless, substantial differences exist between various studies and various indicators. Despite their unconvincing results, high-quality research evidence is needed to support them. In this case, further correlative studies are necessary to investigate the prognostic outcomes of PD-1/PD-L1 suppressors in combination with chemotherapeutic drugs in NSCLC.
The online public databases were searchable for the clinical trials that consisted of NSCLC patients who had concluded their chemotherapy and who had accepted PD-1/PD-L1 suppressors. The time-span of the search spanned from the beginning to the end of the database. Two investigators retrieved the data independently. RevMan 5.3 statistical software was utilized for the assessment of bias risk. The software followed the Cochrane Handbook 5.3 guidelines.
There were seven clinically controlled studies with 2781 NSCLC samples finally included in this study. A meta-analysis of the post-treatment overall response rate (ORR) was undertaken. A remarkably higher ORR rate was observed in the study group (p<0.05). Study participants had a noticeably longer PFS (HR=0.61, 95% CI=0.54-0.70, P<0.00001). Study participants had markedly longer overall survival (OS) (HR=0.651, 95% CI=0.52-0.82, P<0.05). The incidence of adverse events (AEs) of Grade 3 or above was not clinically clearly different (P>0.05), as demonstrated by the incidence of AEs. The funnel plots were separately charted in accordance with ORR rate, PFE, OS, and Grade 3 AEs. The majority of the funnel plots were symmetrical and a minority of funnel plots were asymmetrical, indicating the heterogeneity of research and the limited evidence available may lead to some publication bias in the contained literature.
The combined PD-1/PD-L1 inhibitors with conventional chemotherapy can dramatically elevate the prognosis of NSCLC patients, obviously enhancing the ORR rate and prolonging their PFS and OS. Furthermore, it was found that adding PD-1/PD-L1 inhibitors to conventional chemotherapy did not result in any additional adverse effects.
肺癌是一种常见的恶性肿瘤，严重危害人类生命健康。如今，免疫疗法与化疗联合已逐渐成为非小细胞肺癌（NSCLC）的最佳治疗方法之一，其临床疗效尚处于初步阶段。然而，各项研究及各项指标之间存在显著差异。尽管结果并不令人信服，但仍需要高质量的研究证据来支持。在此情况下，有必要进行进一步的相关性研究，以探究PD-1/PD-L1抑制剂与化疗药物联合用于NSCLC的预后结果。
在在线公共数据库中检索由已完成化疗且接受PD-1/PD-L1抑制剂治疗的NSCLC患者组成的临床试验。检索时间跨度为数据库开始至结束。两名研究人员独立检索数据。采用RevMan 5.3统计软件评估偏倚风险。该软件遵循Cochrane手册5.3指南。
本研究最终纳入7项临床对照研究，共2781例NSCLC样本。对治疗后的总缓解率（ORR）进行了荟萃分析。研究组观察到显著更高的ORR率（p<0.05）。研究参与者的无进展生存期（PFS）明显更长（HR=0.61，95%CI=0.54 - 0.70，P<0.00001）。研究参与者的总生存期（OS）明显更长（HR=0.651，95%CI=0.52 - 0.82，P<0.05）。3级及以上不良事件（AE）的发生率在临床上无明显差异（P>0.05），不良事件发生率表明了这一点。根据ORR率、PFE、OS和3级AE分别绘制漏斗图。大多数漏斗图是对称的，少数漏斗图不对称，表明研究的异质性以及现有证据有限可能导致所包含文献中存在一些发表偏倚。
PD-1/PD-L1抑制剂与传统化疗联合可显著提高NSCLC患者的预后，明显提高ORR率，延长其PFS和OS。此外，发现将PD-1/PD-L1抑制剂添加到传统化疗中不会导致任何额外的不良反应。
