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2017 ; 9
(3
): 655-665
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Anti-PD-1/PD-L1 antibody versus conventional chemotherapy for previously-treated,
advanced non-small-cell lung cancer: a meta-analysis of randomized controlled
trials
#MMPMID28449473
Zhuansun Y
; Huang F
; Du Y
; Lin L
; Chen R
; Li J
J Thorac Dis
2017[Mar]; 9
(3
): 655-665
PMID28449473
show ga
BACKGROUND: The anti-PD-1/PD-L1 monoclonal antibody has showed promising results
in various cancers via enhancing T cell functions. However, many questions remain
in the role and safety in previously-treated, advanced non-small-cell lung cancer
(NSCLC). Thus, we conducted a meta-analysis incorporating all available evidences
to evaluate the efficacy and safety of anti-PD-1/PD-L1 antibody compared with
chemotherapy. METHODS: PubMed, Web of Science and the Cochrane Library database
were searched for the studies about the efficacy and safety of anti-PD-1/PD-L1
antibody in previously-treated, progressive NSCLC patients. Only randomized
controlled trials (RCTs) comparing anti-PD-1/PD-L1 antibody with conventional
chemotherapy in NSCLC were included. Overall survival (OS) in the
intention-to-treat population was the primary outcome. The secondary outcomes
were: progression-free survival (PFS) in the intention-to-treat population,
objective response rate (ORR), the incidence of adverse events, OS and PFS in
different PD-L1 expression subgroups. RESULTS: Four trials with a total of 2,174
patients were included. Anti-PD-1/PD-L1 antibody showed a significant benefit to
OS in the intention-to-treat population [combined hazard ratio (HR) 0.67; 95% CI:
0.61-0.75, P<0.00001], a 33% reduction in the relative risk of death. PFS also
favored anti-PD-1/PD-L1 antibody (HR 0.81, 95% CI: 0.70-0.95, P=0.009). The ORR
was significantly higher with anti-PD-1/PD-L1 antibody than those with
chemotherapy (RR of nonresponse, 0.92; 95% CI: 0.89-0.95, P<0.00001).
Anti-PD-1/PD-L1 antibody was associated with greater efficacy than chemotherapy
across the end points of OS and PFS when tumor PD-L1 expression scored ?1%, ?5%,
and ?50%, except for tumor PD-L1 expression scored <1%. The group receiving
anti-PD-1/PD-L1 antibody had lower rates of treatment-related adverse events of
any grade (RR 0.77; 95% CI: 0.73-0.81, P<0.00001) and treatment-related adverse
events of grade 3-5 (RR 0.24; 95% CI: 0.14-0.41, P<0.00001). CONCLUSIONS:
Anti-PD-1/PD-L1 antibody significantly improved survival compared with
chemotherapy in previously-treated, progressive NSCLC patients. Besides, it also
had a better safety profile.