OBJECTIVES: The treatment landscape in ES/LA-NSCLC is rapidly evolving with new treatment options for patients including immunotherapy (IO) and targeted therapies. Since any new treatment preparing for reimbursement may need to demonstrate relative treatment efficacy and safety against new-to-market comparator(s), we conducted a forward-looking NMA feasibility study to gain insight into considerations when developing future indirect treatment comparisons for ongoing trials with results currently unavailable in ES/LA-NSCLC.

METHODS: Using systematic literature review (SLR) methodology, we reviewed SLRs/NMAs in ES/LA-NSCLC (stage IB−III) to identify currently-available curative treatment options. We supplemented this with a search via clinicaltrials.gov for ongoing trials. We extracted key information across relevant studies and conducted an NMA feasibility study, with separate networks in resectable and unresectable ES/LA-NSCLC.

RESULTS: New IO and targeted therapies are currently under investigation in both resectable and unresectable disease. There are however limited options available to comparatively analyze those treatments targeting actionable alterations due to differences in patient populations and/or choice of comparator(s). For outcome selection in NMAs, the most commonly-reported endpoints in resectable ES/LA-NSCLC include major pathological response rate, disease-free survival and overall survival. A future NMA in ES/LA-NSCLC should also consider an analysis by drug-class to maximize the number of trials available for evaluation, and by specific type of treatment to guide reimbursement decision-making, although the latter approach causes some trials to disconnect from the network. Based on the primary trial completion dates reported on clinicaltrials.gov, in resectable NSCLC there will be a gradual release of data from 2020—2023, steadily increasing options for analysis over time.

CONCLUSIONS: The treatment landscape for ES/LA-NSCLC is complex with limited NMAs available. Careful consideration is needed on how to maximize the connections of newer treatments within an NMA, while maintaining the validity of the analysis to guide decision-making.