Comparing the effectiveness and safety of chemotherapy-based combination therapies as first-line treatment for advanced non-small cell lung cancer with negative PD-L1.

This study compared the effectiveness and safety of chemotherapy-based combination therapies for the treatment of patients with advanced non-small cell lung cancer (NSCLC) with negative PD-L1 expression. The data showed that pembrolizumab (Keytruda) plus chemotherapy combination was the best treatment regimen for improving overall survival and the second safest in these patients. Nivolumab (Opdivo) combined with bevacizumab (Avastin) and chemotherapy was the best treatment regimen for improving survival without cancer worsening in these patients.

NSCLC is the most common form of lung cancer. NSCLC is responsible for around 85% of all lung cancer diagnoses. Standard treatment for advanced NSCLC involves surgical removal of solid tumors, chemotherapy, immunotherapy, and radiotherapy.

Immunotherapy uses the body’s own system to fight cancer. Tumor cells try to avoid death by switching off our immune system. They bind to proteins on the surface of the immune cells such as PD-1/PD-L1. These proteins can stop the immune system from killing cancerous cells. Pembrolizumab and nivolumab are PD-1 and PD-L1 inhibitors that work by inhibiting (blocking) PD-1/PD-L1. This inhibition triggers the immune system to attack tumor cells and kill them.

Bevacizumab is a biological (or targeted) drug that works by blocking the production of new blood vessels needed for tumor growth. Chemotherapy combined with other therapies such as immunotherapy and targeted therapy has significantly improved the outcomes of patients with advanced NSCLC. However, which chemotherapy-based combination therapies are the best for treating patients with advanced NSCLC with negative PD-L1 expression is still unknown.

This study analyzed 16 studies that involved patients with advanced NSCLC with negative PD-L1 expression. In 12 studies, patients were treated with immunotherapy combined with chemotherapy regimens. In 8 studies, patients were treated with anti-angiogenic (AA) targeted therapy plus chemotherapy. AA includes drugs that block the formation of new blood vessels in the tumor.

Pembrolizumab plus chemotherapy combination had the highest probability of being the best treatment regimen for better overall survival (OS).

Nivolumab combined with bevacizumab and chemotherapy had the highest probability of being the best treatment regimen for better survival without worsening cancer.

Sintilimab (Tyvyt) plus chemotherapy combination was the best treatment regimen followed by pembrolizumab plus chemotherapy combination in terms of the least side effects.

This study concluded that pembrolizumab plus chemotherapy combination was the best treatment regimen for improving overall survival and the second safest in patients with advanced NSCLC with negative PD-L1 expression. Nivolumab combined with bevacizumab and chemotherapy was the best treatment regimen for improving survival without cancer worsening in these patients.

This study looked back in time at medical records. More studies directly comparing the different chemotherapy-based combination therapies are needed to validate the conclusions.