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
Moderator
Vassiki Sanogo, BA, MSc, PhD, Integrity Analytics, Haines City, FL, United States
Speakers
Dweeti Nayak, MS, Precision Medicine Group, Jersey City, NJ, United States; Sree Mangala Chava, MSc, Petauri, Ladera Ranch, CA, United States; Reem D Almutairi, MSc, PhD; Karam Diaby, BSc, MSc, PhD, Otsuka, Princeton, NJ, United States
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)