OBJECTIVES: Programmed death (PD)-1 and PD-ligand 1 (PD-L1) inhibitors are used as monotherapies or in combination with other agents to treat non-small cell lung cancer (NSCLC), a leading cause of cancer deaths worldwide. We conducted a systematic search to compare the efficacy of PD-1/PD-L1 inhibitors in the treatment of NSCLC.

METHODS: A systematic literature search of PubMed was conducted to identify phase III clinical trials in which the efficacy of PD-1/PD-L1 inhibitors in the treatment of NSCLC was evaluated. PD-1 inhibitors included nivolumab and pembrolizumab; PD-L1 inhibitors included atezolizumab, avelumab, and durvalumab. Patient characteristics and efficacy data were extracted.

RESULTS: Sixteen phase III clinical trials were identified (nivolumab=4; pembrolizumab=5; atezolizumab=5; avelumab=1; durvalumab=1). Across the 3 nivolumab monotherapy trials (n=638; median ages: 61-63 years), median progression-free survival (PFS) ranged 2.3-4.2 months; response rates ranged 19%-26%. Nivolumab in combination with iplimumab (n=583; median age: 64 years) had a median PFS of 5.1 months and response rate of 33%. Across the 3 pembrolizumab monotherapy trials (n=1,481; median ages: 63-64 years), median PFS ranged 3.9-10.3 months; response rates ranged 18%-45%. In the 2 pembrolizumab combination therapy trials (n=688; median ages: 65 years), median PFS ranged 6.4-8.8 months; response rates ranged 48%-58%. In the 4 atezolizumab combination therapy trials (n=1,486; median ages: 63-64 years), median PFS ranged 6.3-8.3 months; response rates ranged 47%-63.5%. In the 3 monotherapy trials of atezolizumab (n=613; median age: 63 years), avelumab (n=396; median age: 64 years), and durvalumab (n=476; median age: 64 years), the median months of PFS were 2.7, 2.8, and 17.2, respectively; response rates were 14%, 15%, and 30%, respectively.

CONCLUSIONS: Most of the evaluated PD-1/PD-L1 inhibitors improved outcomes of NSCLC clinical trial patients; however, responses varied. This efficacy comparison of PD-1/PD-L1 inhibitors in the treatment of NSCLC may be of value to healthcare providers and payers.