Comparing the effectiveness and safety of single and double immune checkpoint inhibitor-based first-line treatments for advanced non-small cell lung cancer.

This study compared the effectiveness and safety outcomes of single and double immune checkpoint inhibitors (ICI)-based treatments in patients with advanced non-small-cell lung cancer (NSCLC). The data showed that the effectiveness and safety of both single and double ICI-based treatments were similar and higher than chemotherapy for the treatment of patients with advanced NSCLC.

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 pembrolizumab (Keytruda) and ipilimumab (Yervoy) block these interactions and turns on the immune system to attack and kill the cancer cells. PD-1/PD-L1 and CTLA-4 inhibitors as a first-line treatment have been found to significantly improve the outcomes of patients with advanced NSCLC. However, there are very few studies comparing the effectiveness and safety outcomes of single and double ICI-based treatments in patients with advanced NSCLC.

This study involved 20 studies involving 13,032 patients with advanced wild-type NSCLC. Single ICI-based treatments included were- PD-1/PD-L1 or CTLA-4 inhibitors alone or with chemotherapy. Double ICI-based treatments included combinations of PD-1/PD-L1 inhibitors + CTLA-4 inhibitors with or without chemotherapy.

The average overall survival of single ICI-based treatments was 16.17 months compared to 14.81 months for double ICI-based treatments. There were no significant differences in terms of overall survival, survival without cancer worsening, overall response to treatment, and severe side effects between single and double ICI-based treatments.

Patients who received single ICI-based treatments were 22% more likely and those who received double ICI-based treatments were 26% more likely to have a better overall survival than those who received chemotherapy alone.  

Patients who received single ICI-based treatments were 31% more likely to survive without cancer worsening than those who received chemotherapy. Also, these patients were 1.76 times more likely to respond to treatment better than those who received chemotherapy.

Double ICI-based treatments were more effective than single ICI-based treatments in patients with squamous NSCLC and PD-L1 expression of less than 1%.

This study concluded that the effectiveness and safety of both single and double ICI-based treatments were similar and better than chemotherapy for the treatment of patients with advanced NSCLC.

Some studies in this analysis also included a few patients with driver-gene mutated advanced NSCLC. Further larger studies are needed to fully evaluate the effectiveness and safety of double ICI-based treatments.