背景:程序性死亡1(PD-1)/程序性死亡1配体1(PD-L1)定向免疫疗法彻底改变了晚期非小细胞肺癌(NSCLC)的治疗方法,而最佳治疗组合仍不确定。
方法:我们的研究包括Ⅱ期/Ⅲ期随机对照试验(RCT),这些试验涉及IV期NSCLC的抗PD-(L)1治疗。主要结果包括总生存期(OS),无进展生存期(PFS),客观反应率(ORR),和不良事件(AE)的发生率。亚组分析按治疗线进行,PD-L1表达水平,组织学类型,和转移部位。
结果:我们的分析纳入了38种出版物,涵盖14种治疗组合,涉及18,048名参与者。PD-(L)1+化疗(CT),PD-(L)1+细胞毒性T淋巴细胞相关抗原-4(CTLA4)+CT,PD-(L)1+T细胞免疫球蛋白和ITIM结构域(TIGIT)对延长OS显著有效。总的来说,PD-(L)1+CT和PD-(L)1+CT+血管内皮发展因子(VEGF)对PFS和ORR均有显著影响。至于后续的线处理,纳入放疗可提高PFS和ORR(在纳入治疗中排名第四).对于PD-L1<1%的患者,PD-(L)1+CT+VEGF和PD-(L)1+CTLA4+CT是较好的方法。相反,在PD-L1≥50%的患者中,PD-(L)1+CT代表了一种有效的治疗方法。非鳞状细胞癌或肝转移患者可能受益于VEGF的添加。在鳞状细胞癌或脑转移的情况下,PD-(L)1+CTLA4+CT的联合应用效果更佳.
结论:本研究强调了联合免疫疗法相对于单一疗法的疗效增强。它强调了个性化治疗的必要性,考虑到个人因素。这些见解对于晚期NSCLC的临床决策至关重要。
BACKGROUND: Programmed death 1 (PD-1)/programmed death 1 ligand 1 (PD-L1)-directed immunotherapy has revolutionized the treatments for advanced non-small cell lung cancer (NSCLC), whereas the optimal therapeutic combinations remain uncertain.
METHODS: Our study encompassed phase Ⅱ/III randomized controlled trials (RCTs) that involved anti-PD-(L)1-based therapies for stage-IV NSCLC. The primary outcomes included overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and incidences of adverse events (AEs). Subgroup analyses were conducted by treatment lines, PD-L1 expression levels, histological types, and metastatic sites.
RESULTS: Our analysis incorporated 38 publications, covering 14 therapeutic combinations and involving 18,048 participants. PD-(L)1+chemotherapy (CT), PD-(L)1+ cytotoxic T lymphocyte-associated antigen-4 (CTLA4) +CT, and PD-(L)1+ T-cell immunoglobulin and ITIM domain (TIGIT) were notably effective in prolonging OS. Overall, PD-(L)1+CT and PD-(L)1+CT+ vascular endothelial growth factor (VEGF) were significantly beneficial for PFS and ORR. As for the subsequent-line treatments, incorporating radiotherapy can enhance PFS and ORR (ranked fourth among enrolled treatments). For patients with PD-L1 < 1%, PD-(L)1+CT+VEGF and PD-(L)1+CTLA4+CT were favorable approaches. Conversely, in patients with PD-L1 ≥ 50%, PD-(L)1+CT represented an effective treatment. Patients with non-squamous cell carcinoma or liver metastases might benefit from the addition of VEGF. In cases of squamous cell carcinoma or brain metastases, the combination of PD-(L)1+CTLA4+CT yielded superior benefits.
CONCLUSIONS: This study underscores the enhanced efficacy of combination immunotherapies over monotherapy. It highlights the necessity for personalized treatment, considering individual factors. These insights are vital for clinical decision-making in the management of advanced NSCLC.