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Posted by on Oct 16, 2021 in Lung cancer | 0 comments

In a nutshell

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.

Some background

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.

Methods & findings

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%.

The bottom line

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.

The fine print

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.

Published By :

Frontiers in immunology

Date :

Sep 07, 2021

Original Title :

Comparison of Efficacy and Safety of Single and Double Immune Checkpoint Inhibitor-Based First-Line Treatments for Advanced Driver-Gene Wild-Type Non-Small Cell Lung Cancer: A Systematic Review and Network Meta-Analysis.

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