PDF(Pubmed)
Abstract：
Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, often diagnosed at the advanced stage (metastatic). Treatment options for metastatic NSCLC include radiotherapy, chemotherapy, target drug therapy, and immunotherapy. Immunotherapy (utilization of checkpoint inhibitors) boosts the immune system to recognize and destroy cancer cells. However, it is often associated with immune-related complications such as pneumonitis. This review aims to determine the incidence of pneumonitis in metastatic NSCLC patients treated with different immunotherapy drugs. PubMed, Cochrane Library, and Embase databases were scoured for randomized controlled trials (RCTs) until October 2023. Published RCTs with similar research objectives were included, while non-English articles, reviews, case reports, ongoing trials, non-randomized studies, conference abstracts, and studies on small cell lung cancer (SCLC) were excluded. The Cochrane risk-of-bias tool for randomized trials (RoB 2) was used to assess the risk of bias among the included studies. The statistical analyses were performed with the Comprehensive Meta-Analysis software. The subgroup analysis of the 16 included RCTs showed that metastatic NSCLC patients treated with nivolumab and pembrolizumab had a higher incidence of any grade pneumonitis than those treated with atezolizumab (4.5% and 5.1% vs. 1.6%, respectively). Similarly, the incidence of grade ≥3 pneumonitis was higher among patients receiving nivolumab (1.3%) and pembrolizumab (2.4%) than those receiving atezolizumab (0.7%). Furthermore, the subgroup analysis showed that patients with naive-treated NSCLC on immunotherapy had a higher incidence of any grade pneumonitis than those with previously treated NSCLC (6.5% vs. 3.9%). Treatment-naive patients recorded higher grade ≥3 pneumonitis incidences than those previously treated (3.1% vs. 1.3%). Programmed death 1 (PD-1) inhibitors (i.e., pembrolizumab and nivolumab) have higher incidences of pneumonitis than programmed death-ligand 1 inhibitors (atezolizumab).
摘要：
非小细胞肺癌（NSCLC）是最常见的肺癌类型，通常在晚期诊断（转移性）。转移性NSCLC的治疗选择包括放疗，化疗,目标药物治疗，和免疫疗法。免疫疗法（使用检查点抑制剂）可增强免疫系统以识别和破坏癌细胞。然而,它通常与免疫相关的并发症如肺炎有关.本文旨在确定接受不同免疫治疗药物治疗的转移性NSCLC患者肺炎的发生率。PubMed,科克伦图书馆,和Embase数据库进行随机对照试验(RCT),直至2023年10月.包含具有类似研究目标的已发表RCT，而非英语文章，reviews,病例报告,正在进行的试验,非随机研究，会议摘要，小细胞肺癌（SCLC）的研究被排除。使用Cochrane随机试验偏倚风险工具（RoB2）评估纳入研究的偏倚风险。采用综合Meta分析软件进行统计分析。对16个纳入RCT的亚组分析显示，接受纳武单抗和派博利珠单抗治疗的转移性NSCLC患者的任何级别肺炎发生率均高于接受阿特珠单抗治疗的患者（4.5％和5.1％vs.1.6%,分别)。同样，接受纳武单抗(1.3%)和派博利珠单抗(2.4%)的患者的≥3级肺炎发生率高于接受阿特珠单抗(0.7%).此外，亚组分析显示，接受免疫治疗的初次治疗的NSCLC患者的任何级别肺炎发生率均高于先前治疗的NSCLC患者(6.5%vs.3.9%）。未接受治疗的患者记录的≥3级肺炎发生率高于先前接受治疗的患者（3.1％vs.1.3%）。程序性死亡1(PD-1)抑制剂(即，pembrolizumab和nivolumab）的肺炎发生率高于程序性死亡配体1抑制剂（阿特珠单抗）。
