Comparing Chemotherapy, Monotherapy, and Combination Immune Checkpoint Inhibitors for Non-Small-Cell Lung Cancer Progression-Free Survival and Overall Survival: Systematic Review and Meta-Analysis
Author(s)
Vassiki Sanogo, MSc, PhD1, Dweeti Nayak, MS2, Sree Mangala Chava, MSc3, Reem D. Almutairi, MSc, PhD1, Karam Diaby, BSc, MSc, PhD4;
1Integrity Analytics, Haines City, FL, USA, 2Precision AQ, New York, Remote, NY, USA, 3The London School of Economics and Political Science, Ladera Ranch, CA, USA, 4University of Florida, Pharmaceutical Outcomes and Policy, Gainesville, FL, USA
1Integrity Analytics, Haines City, FL, USA, 2Precision AQ, New York, Remote, NY, USA, 3The London School of Economics and Political Science, Ladera Ranch, CA, USA, 4University of Florida, Pharmaceutical Outcomes and Policy, Gainesville, FL, USA
Presentation Documents
OBJECTIVES: Progression-free survival (PFS) and overall survival (OS) are key metrics for assessing cancer treatments. Clinical guidelines recommend immune checkpoint inhibitors (ICIs) for non-small-cell lung cancer (NSCLC), though optimal strategies remain elusive. We conducted a systematic review and meta-analysis (MA) of clinical trials to evaluate ICI therapy's impact on PFS and OS in NSCLC patients.
METHODS: MAs of the literature performed using PubMed, Embase, Web of Science, ClinicalTrial.gov, and Cochrane databases through August 2024, adhering to PRISMA guidelines. RCTs evaluating the efficacy of monotherapy/combination ICI therapies in advanced NSCLC patients were included based on pre-defined criteria. Data—including study type, first author, publication year, study period, clinical/demographic characteristics, ICI therapies, and survival outcomes—were extracted by four authors into an Excel spreadsheet. Survival data, reported as HRs with 95% CIs, were analyzed using the random-effects DerSimonian-Laird method in the Meta package with R 3.6.0 software. Results were presented as Forest plots. Sensitivity analysis included only studies reporting adjusted survival outcomes. Heterogeneity was assessed using I² and associated p-values. Bias was evaluated using funnel plot symmetry.
RESULTS: Analyses encompassed 22 studies, of which 21 were utilized for PFS, with 9,874 advanced NSCLC patients. MAs on outcomes revealed significant directional differences between interventions and controls, with lower HRs: PFS (HR=0.83 [95% CI: 0.75-0.92]) and not significant for OS (HR=0.99 [95% CI: 0.71-1.38]). The MA subgroup analyses of individual ICI drugs and therapeutic strategies showed significant lower HRs for Cemiplimab (PFS: HR=0.78 [95% CI: 0.76-0.79]) and Pembrolizumab-based therapy, with PFS (HR=0.83 [95% CI: 0.75-0.92]) and OS (HR=0.84 [95% CI: 0.43-1.63]); and for combination ICI therapy versus chemotherapy, with PFS (HR=0.53 [95% CI: 0.33-0.83]) and OS (HR=0.57 [95% CI: 0.32-1.01]).
CONCLUSIONS: ICI therapies show a lower probability of the outcomes’ events, though statistical significance was established for PFS and not for OS. Pembrolizumab-based ICI combinations demonstrate the best performance.
METHODS: MAs of the literature performed using PubMed, Embase, Web of Science, ClinicalTrial.gov, and Cochrane databases through August 2024, adhering to PRISMA guidelines. RCTs evaluating the efficacy of monotherapy/combination ICI therapies in advanced NSCLC patients were included based on pre-defined criteria. Data—including study type, first author, publication year, study period, clinical/demographic characteristics, ICI therapies, and survival outcomes—were extracted by four authors into an Excel spreadsheet. Survival data, reported as HRs with 95% CIs, were analyzed using the random-effects DerSimonian-Laird method in the Meta package with R 3.6.0 software. Results were presented as Forest plots. Sensitivity analysis included only studies reporting adjusted survival outcomes. Heterogeneity was assessed using I² and associated p-values. Bias was evaluated using funnel plot symmetry.
RESULTS: Analyses encompassed 22 studies, of which 21 were utilized for PFS, with 9,874 advanced NSCLC patients. MAs on outcomes revealed significant directional differences between interventions and controls, with lower HRs: PFS (HR=0.83 [95% CI: 0.75-0.92]) and not significant for OS (HR=0.99 [95% CI: 0.71-1.38]). The MA subgroup analyses of individual ICI drugs and therapeutic strategies showed significant lower HRs for Cemiplimab (PFS: HR=0.78 [95% CI: 0.76-0.79]) and Pembrolizumab-based therapy, with PFS (HR=0.83 [95% CI: 0.75-0.92]) and OS (HR=0.84 [95% CI: 0.43-1.63]); and for combination ICI therapy versus chemotherapy, with PFS (HR=0.53 [95% CI: 0.33-0.83]) and OS (HR=0.57 [95% CI: 0.32-1.01]).
CONCLUSIONS: ICI therapies show a lower probability of the outcomes’ events, though statistical significance was established for PFS and not for OS. Pembrolizumab-based ICI combinations demonstrate the best performance.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
CO86
Topic
Clinical Outcomes
Disease
SDC: Oncology, SDC: Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)