广泛期小细胞肺癌一线治疗，PD-L1 抑制剂与 PD-1 抑制剂，孰优孰劣？系统评价与网络荟萃分析。

Which Is More Suitable for First-Line Treatment of Extensive-Stage Small Cell Lung Cancer, PD-L1 Inhibitors Versus PD-1 Inhibitors? A Systematic Review and Network Meta-Analysis.

机构信息

Department of Medical Oncology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.

Department of Medical Oncology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China.

出版信息

Clin Respir J. 2024 Jul;18(7):e13804. doi: 10.1111/crj.13804.

BACKGROUND

In this network meta-analysis (NMA), the efficiency and safety of PD-1 inhibitors + chemotherapy and PD-L1 inhibitors + chemotherapy were compared in the first-line therapy of patients with extensive-stage small cell lung cancer (ES-SCLC).

METHODS

We searched research databases, conference abstracts, and trial registries and subsequently chose relevant studies and extracted dates. The NMA was conducted to estimate the efficiency and safety of the PD-1 inhibitors + chemotherapy and PD-L1 inhibitors + chemotherapy on overall survival (OS), progression-free survival (PFS), overall remission rate (ORR), and adverse events (AEs). Studies were assessed for quality. Subgroup analyses were used to evaluate study heterogeneity.

RESULTS

We included six randomized trials with a total of 3163 patients. Direct comparisons showed that patients who received either PD-1 inhibitors + chemotherapy (HR: 0.71, 95% CI: 0.57-0.87) or PD-L1 inhibitors + chemotherapy (HR: 0.74, 0.61-0.89) demonstrated significantly longer OS than those who received placebo + chemotherapy. The results of the NMA showed that no significant differences in OS (HR 0.96 95% CI: 0.72-1.3), PFS (HR 0.83, 95% CI: 0.51-1.4), and ORR (OR 1.3 95% CI: 0.66-2.5) were observed for PD-1 inhibitors + chemotherapy compared with PD-L1 inhibitors + chemotherapy, but the Bayesian ranking revealed that patients receiving PD-1 inhibitors + chemotherapy tended to have longer OS, PFS benefit, and better treatment response than patients receiving PD-L1 inhibitors + chemotherapy. In terms of safety, no significant difference was observed in their safety profiles.

CONCLUSION

In comparison to placebo + chemotherapy, PD-L1 inhibitors + chemotherapy and PD-1 inhibitors + chemotherapy significantly improved survival for ES-SCLC. According to the available data, PD-L1 inhibitors + chemotherapy and PD-1 inhibitors + chemotherapy had equivalent efficacy and safety; however, the level of evidence of this type of comparison is limited.

背景

在这项网络荟萃分析（NMA）中，比较了 PD-1 抑制剂联合化疗与 PD-L1 抑制剂联合化疗在广泛期小细胞肺癌（ES-SCLC）一线治疗中的疗效和安全性。

方法

我们检索了研究数据库、会议摘要和试验注册处，随后选择了相关研究并提取了数据。采用 NMA 来评估 PD-1 抑制剂联合化疗与 PD-L1 抑制剂联合化疗对总生存期（OS）、无进展生存期（PFS）、总缓解率（ORR）和不良事件（AEs）的疗效和安全性。研究质量进行了评估。采用亚组分析来评估研究异质性。

结果

我们纳入了 6 项随机试验，共 3163 例患者。直接比较显示，接受 PD-1 抑制剂联合化疗（HR：0.71，95%CI：0.57-0.87）或 PD-L1 抑制剂联合化疗（HR：0.74，0.61-0.89）的患者的 OS 明显长于接受安慰剂联合化疗的患者。NMA 的结果显示，PD-1 抑制剂联合化疗与 PD-L1 抑制剂联合化疗在 OS（HR 0.96，95%CI：0.72-1.3）、PFS（HR 0.83，95%CI：0.51-1.4）和 ORR（OR 1.3，95%CI：0.66-2.5）方面无显著差异，但贝叶斯排序显示，接受 PD-1 抑制剂联合化疗的患者的 OS、PFS 获益和治疗反应均优于接受 PD-L1 抑制剂联合化疗的患者。在安全性方面，两者的安全性特征无显著差异。