Comparing the effectiveness and safety of PD-1/PD-L1 inhibitors versus chemotherapy for the treatment of patients with non-small-cell lung cancer.

This study compared the effectiveness and safety outcomes of different programmed death-1 (PD-1)/PD ligand 1 (PD-L1) inhibitors versus chemotherapy for the treatment of patients with non-small-cell lung cancer (NSCLC). The data showed that PD-1/PD-L1 inhibitors were safer and more effective than chemotherapy with cemiplimab (Libtayo) being the most effective in improving the overall survival of 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 the immune system. They bind to proteins on the surface of the immune cells such as PD-1/PD-L1. Immune checkpoint inhibitors (ICIs) such as pembrolizumab (Keytruda), nivolumab (Opdivo), atezolizumab (Tecentriq), and avelumab (Bavencio) block these interactions and turn on the immune system to attack and kill the cancer cells.  

PD-1/PD-L1 inhibitors as a first-line treatment have been found to significantly improve the outcomes of patients with advanced NSCLC. However, there are few studies investigating the effectiveness and safety outcomes of different PD-1/PD-L1 inhibitors versus chemotherapy and determining the best regimen for the treatment of patients with NSCLC.

This study analyzed 13 other studies that involved 7795 patients with NSCLC. 369 patients received avelumab, 903 patients received atezolizumab, 356 patients received cemiplimab, 1036 patients received nivolumab, 1481 patients received pembrolizumab, and 3623 patients received chemotherapy.

Overall survival was significantly improved in patients treated with atezolizumab (by 23%), in patients treated with nivolumab (by 25%), and in patients treated with pembrolizumab (by 29%) compared with chemotherapy. Overall survival was improved in patients treated with cemiplimab (by 32%) compared with chemotherapy.

The risk of experiencing treatment-related side effects was reduced in patients treated with avelumab (by 70%), in patients treated with atezolizumab (by 68%), in patients treated with nivolumab (by 73%), in patients treated with pembrolizumab (by 70%), in patients treated with cemiplimab (by 83%) compared with chemotherapy.

Cemiplimab had the highest probability (49.5%) of being the best treatment regimen in terms of improving overall survival.

This study concluded that PD-1/PD-L1 inhibitors were safer and more effective than chemotherapy with cemiplimab being the most effective in improving the overall survival in patients with NSCLC.

This study analyzed data in different other studies with different methodologies and chemotherapies used. Most of the studies analyzed had a short follow-up period. This study did not directly compare the different PD-1/PD-L1 inhibitors.