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First-line PD-1/PD-L1 inhibitor plus chemotherapy vs chemotherapy alone for negative or < 1% PD-L1-expressing metastatic non-small-cell lung cancers

  • Thierry LandreEmail author
  • Gaetan Des Guetz
  • Kader Chouahnia
  • Cherifa Taleb
  • Alain Vergnenègre
  • Christos Chouaïd
Original Article – Clinical Oncology
  • 34 Downloads

Abstract

Aims

Single-agent anti-PD-1/PD-L1 clinical efficacy against < 1% PD-L1-expressing non-small-cell lung cancers (NSCLCs) is controversial.

Methods

This meta-analysis examined randomized-trial data comparing first-line PD-1/PD-L1-inhibitor + chemotherapy (CT) vs CT alone for advanced < 1% PD-L1 NSCLCs. Outcome measures included overall survival (OS), progression-free survival (PFS) and objective response rate (ORR).

Results

IMpower (atezolizumab + CT), Keynote (pembrolizumab + CT) and CheckMate (nivolumab + CT) trials included 2037 NSCLCs (1246 PD-L1–negative; 791 < 1% PD-L1 expression). Anti-PD-1/PD-L1 + CT was significantly associated (hazard ratio [95% confidence interval]) with prolonged OS (0.75 [0.63–0.89]; p = 0.0008) and PFS (0.72 [0.65–0.80]; p < 0.0001), and higher ORR (odds ratio 2.06 [1.50–2.83]; p < 0.0001).

Conclusions

First-line anti-PD-1/PD-L1 + CT combination appears superior to CT alone for advanced, < 1% PD-L1-expressing NSCLCs for OS, PFS and ORR.

Keywords

Non-small-cell lung cancer PD-L1 Anti-PD-1/PD-L1 Immunotherapy Meta-analysis Management Chemotherapy 

Abbreviations

ALK

Anaplastic lymphoma kinase

ChT

Chemotherapy

CI

Confidence interval

DOR

Duration of response

EGFR

Epidermal growth factor receptor

HR

Hazard ratio

ICI

Immune-checkpoint inhibitor

NSCLC

Non-small-cell lung cancer

Nsq

Non-squamous cell

OR

Odds ratio

ORR

Objective response rate

OS

Overall survival

PD-1

Programmed cell-death protein-1

PD-L1

Programmed cell-death protein-1 ligand

PFS

Progression-free survival

Sq

Squamous cell

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.UCOG 93Hôpital René-Muret, APHPSevranFrance
  2. 2.Service d’Oncologie MédicaleCentre Hospitalier DelafontaineSaint-DenisFrance
  3. 3.Service d’Oncologie MédicaleHôpital Avicenne, APHPBobignyFrance
  4. 4.Service d’OncogériatrieHôpital René-Muret, APHPSevranFrance
  5. 5.Service d’Oncologie Médicale, Unité d’Oncologie ThoraciqueLimogesFrance
  6. 6.Service de PneumologieCentre Hospitalier Intercommunal (CHI) CréteilCréteilFrance

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