Comparing the effectiveness and safety of nivolumab plus ipilimumab with chemotherapy versus pembrolizumab plus chemotherapy as first-Line treatment for metastatic NSCLC.

This study compared the effectiveness and safety outcomes of nivolumab (N; Opdivo) plus ipilimumab (I; Yervoy) with chemotherapy versus pembrolizumab (Pem; Keytruda) plus chemotherapy as first-line treatment in patients with metastatic non-small cell lung cancer (NSCLC). The data showed that N-I plus chemotherapy provided similar overall survival benefits as Pem plus chemotherapy and is a promising treatment option for 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, and radiotherapy.

Immunotherapy uses the body’s own system to fight cancer and has been found to be effective in advanced NSCLC. 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 or CTLA-4. Immune checkpoint inhibitors (ICI) such as Pem, N, and I block these interactions and turns on the immune system to attack and kill the cancer cells.

N-I plus chemotherapy and Pem plus chemotherapy were both recommended as first-line treatment for patients with metastatic NSCLC. However, there are very few studies comparing the effectiveness and safety outcomes of these two treatment regimens in patients with metastatic NSCLC.

This study analyzed 4 studies involving 2017 patients with metastatic NSCLC. They were treated with either N+I and chemotherapy or with Pem and chemotherapy as first-line therapy.

There were no significant differences in terms of overall survival, overall response to treatment, and severe side effects between N+I plus chemotherapy and Pem plus chemotherapy.

However, patients who received N+I plus chemotherapy were 1.28 times more likely to survive without cancer worsening than those who received Pem plus chemotherapy.

For female patients who never smoked, Pem plus chemotherapy was associated with a significant overall survival benefit compared to N+I plus chemotherapy.

N+I plus chemotherapy was associated with fewer risks of low counts of red and white blood cells, and platelets than Pem plus chemotherapy. The overall side effect risks were similar between groups. 

This study concluded that N+I plus chemotherapy provided a similar overall survival benefit as Pem plus chemotherapy and is a promising treatment option for patients with metastatic NSCLC.

This study looked back in time at medical records. This study did not directly compare the effectiveness and safety of the two treatment regimens. The follow-up time in the studies analyzed was too short to fully evaluate the overall survival benefits.