Abstract
Objectives
The project is designed to compare the clinical efficacy and adverse events resulting from immune checkpoint inhibitors (ICIs) plus chemotherapy and chemotherapy alone in patients with small cell lung cancer (SCLC).
Methods
PubMed Database and ClinicalTrials.gov were both searched to identify randomized controlled clinical trials for assessing ICIs in all-stage SCLC. After screening in strict accordance with the inclusion and exclusion criteria, eligible studies were evaluated in regard to the population, intervention, comparator, outcome as well as study design (PICOS) pattern. Furthermore, primary endpoints of these randomized controlled trials (RCTs) included overall survival (OS), progression-free survival (PFS) and complete/objective response rate (CRR/ORR). Statistical analyses were realized via Review Manager Version 5.3 Software.
Results
Compared with the chemotherapy alone group, the ICIs plus chemotherapy group significantly improved with respect to such indicators as OS (hazard ratio (HR) = 0.82, 95% CI 0.74–0.90, P < 0.0001), PFS (HR = 0.80, 95% CI 0.74–0.87, P < 0.00001) and ORR (64.7% versus 59.1%). According to the safety analysis, the incidence of treatment-related adverse events (trAEs) at all grades was higher in ICIs plus chemotherapy group (OR = 1.59, 95% CI 1.20–2.10, P = 0.001), bearing no statistical significance at grade 3 or above (OR = 1.21, 95% CI 0.99–1.49, P = 0.07).
Conclusions
The combination of ICIs and chemotherapy witnessed better anti-neoplastic efficacy for SCLC. Moreover, the incidence of trAEs at all grades was elevated in ICIs plus chemotherapy group, with little discrepancy in both groups at grade 3 or above.
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Availability of data and material
Data available from authors upon reasonable request.
Abbreviations
- ICIs:
-
Immune checkpoint inhibitors
- SCLC:
-
Small cell lung cancer
- NSCLC:
-
Non-small cell lung cancer
- RCTs:
-
Randomized controlled trials
- OS:
-
Overall survival
- PFS:
-
Progression-free survival
- CRR/ORR:
-
Complete/objective response rate
- HR:
-
Hazard ratio
- 95%CI:
-
95% Credible intervals
- trAEs:
-
Treatment-related adverse events
- CTLA-4:
-
Cytotoxic T-lymphocyte-associated protein 4
- PD-1:
-
Programmed death-1
- PD-L1:
-
Programmed cell death-ligand 1
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XX contributed to the conception and design of the study, administrative support, data interpretation, and manuscript writing. YZ participated in data acquisition, statistical analysis, data interpretation as well as manuscript writing. QW was in charge of statistical analysis, data interpretation, and manuscript writing. SW was responsible for data interpretation and manuscript writing.
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Zhong, Y., Wu, Q., Wu, S. et al. Comparing strategy of immune checkpoint inhibitors plus chemotherapy with chemotherapy alone for small cell lung cancer: a meta-analysis based on six RCTs incorporating 2800 participants. J Cancer Res Clin Oncol 148, 2465–2474 (2022). https://doi.org/10.1007/s00432-021-03798-x
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DOI: https://doi.org/10.1007/s00432-021-03798-x