Comparing targeted therapies for patients with advanced non-small-cell lung cancer

The authors aimed to understand the effectiveness of anti-PD-L1 therapy in patients with previously treated non-small-cell lung cancer (NSCLC) compared to current treatments. The authors concluded that anti-PD-L1 therapy could be more beneficial than the chemotherapy drug docetaxel (Taxotere) at treating patients with previously treated NSCLC.

Many tumor cells have a protein (PD-L1) which stops the immune system from killing them. New therapies are available that block PD-L1 and allow the immune system to kill the cancer cells. Anti-PD-L1 therapies include atezolizumab (Tecentriq), pembrolizumab (Keytruda) and nivolumab (Opdivo). Another type of treatment are EGFR-TKIs, which block a protein on tumor cells called EGFR. Tumor cells have a mutation (genetic change) in the gene for EGFR, which allows them to keep growing. It is unknown whether anti-PD-L1 treatment is more effective than EGFR-TKI treatment for treating patients with NSCLC who have progressed passed initial therapies.

This analysis aimed to compare the effectiveness of PD-L1 therapy to EGFR-TKIs for patients with previously treated NSCLC. There is little research directly comparing anti-PD-L1 therapy to EGFR-TKIs. The authors therefore found studies that compared anti-PD-L1 therapy to the chemotherapy drug docetaxel and studies that compared EGFR-TKIs to docetaxel. A total of 14 studies with a combined 3786 patients were included.

Compared to docetaxel, anti-PD-L1 treatment reduced the risk of death by an average of 33%. It resulted in a 17% improved progression free survival (PFS, time from beginning trial until disease progression) and 19% objective response rate (ORR, proportion of patients with tumor reduction). These results were more pronounced in patients with a high level of PD-L1.

When indirectly compared to EGFR-TKIs, anti-PD-L1 therapy was more effective at treating patients without EGFR mutations. For patients with EGFR mutations, EGFR-TKIs resulted in longer PFS.

The authors concluded that anti-PD-L1 treatment could be more beneficial than docetaxel for patients with previously treated NSCLC. In addition, they concluded that anti-PD-L1 treatment could improve outcomes for patients without EGFR mutations.