Is there any place for PD-1/CTLA-4 inhibitors combination in the first-line treatment of advanced NSCLC?—A trial-level meta-analysis in PD-L1 selected subgroups

Antonio Galvano, Maria La Mantia, Viviana Bazan, Nadia Barraco, Valerio Gristina, Antonio Russo, Antonio Russo, Antonio Russo, Valerio Gristina, Antonio Galvano, Marta Castiglia, Francesco Passiglia, Nadia Barraco, Alessandro Perez, Maria La Mantia

Risultato della ricerca: Articlepeer review

9 Citazioni (Scopus)

Abstract

Background: The advent of immuno-oncology (IO) represented a breakthrough in non-small cell lungcancer (NSCLC) therapy over the last few years. However, establishing the optimal therapeutic optionsamong programmed death-ligand 1 (PD-L1) selected subgroups still addresses an unmet need in the clinicalsetting.Methods: We performed a systematic review and finally included eleven first-line randomized controlledtrials to compare efficacy and safety outcomes among first-line IO treatment strategies versus standardplatinum-based chemotherapy (CT) according to PD-L1 expression level (<1%, 1–49%, ≥50%). Pooledhazard ratios (HRs) and risk ratios (RRs) for progression-free survival (PFS), overall survival (OS), objectiveresponse rates (ORR), treatment-related adverse events (TRAEs), and discontinuation rates were obtained.Results: Our results demonstrated that among the different IO-based strategies (single-agent IO, ComboIO, IO+CT) the IO + CT approach resulted in a significant increase of the ORR, albeit with no relevantimprovement of survival in patients with PD-L1 ≥50%. As regards patients with negative PD-L1 expression,no significant differences in terms of activity and efficacy profile have been detected between the IO + CTand the dual checkpoint blockade. Of note, in the PD-L1 1–49% subgroup, the use of anti-PD-1 agentsin association with CT led to a statistically significant gain in OS. As concerns safety, the dual checkpointblockade seemed to be better tolerated than IO+CT.Conclusions: This meta-analysis suggested the current limited role of PD-1/CTLA-4 inhibitorscombination in PD-L1-high and/or -low advanced NSCLC patients while emerging as a potentially effectiveand tolerable option in particular PD-L1 negative subgroups
Lingua originaleEnglish
Numero di pagine25
RivistaTranslational Lung Cancer Research
Stato di pubblicazionePublished - 2021

All Science Journal Classification (ASJC) codes

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