Comparing the effectiveness of immune-based combination therapies as first-line treatment for advanced non-small cell lung cancer.

This study compared the effectiveness of immune-based combination therapies as first-line treatment for advanced non-small-cell lung cancer (NSCLC). The data showed that immunotherapies plus chemotherapy combination was the best treatment for improving overall survival whereas, immunotherapy plus anti-angiogenic therapy plus chemotherapy combination was the best option for improving survival without cancer progression 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 a combination of surgical removal of solid tumors, chemotherapy, targeted therapy, immunotherapy, and/or 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 (Keytruda) and nivolumab (Opdivo) are examples of PD-1 and PD-L1 inhibitors that work by inhibiting (blocking) PD-1/PD-L1. This inhibition triggers the activation of the immune system to attack tumor cells and kills them.

Immunotherapy in combination with other therapies such as chemotherapy and targeted therapy has shown to significantly improve the outcomes of patients with advanced NSCLC. However, which combination therapies as first-line treatments for advanced NSCLC are the best is still unknown. 

This study analyzed 14 other studies that involved 8,467 patients with advanced NSCLC. For first-line treatment, the regimens analyzed were: immunotherapy plus chemotherapy (IT + CT), immunotherapy plus immunotherapy (IT + IT), immunotherapy plus immunotherapy plus chemotherapy (IT + IT + CT), and immunotherapy plus anti-angiogenic therapy plus chemotherapy (IT + AA + CT). AA includes drugs that block the formation of new blood vessels in the tumor.

IT + IT + CT combinations had the highest probability (68%) to be the best treatment regimen in terms of better overall survival (OS). IT + AA + CT combination had the highest probability to be the best treatment regimen in terms of better survival without cancer worsening (99%) and objective response rate (ORR; partial or complete disappearance of cancer; 58%).

In patients with a high expression of PD-L1, IT + AA + CT had the highest probability to be the best treatment regimen in terms of better outcomes.

In patients with an intermediate expression of PD-L1, IT + IT + CT combinations had the highest probability to be the best treatment in terms of better OS (78%). IT + AA + CT had the highest probability to be the best treatment in terms of better survival without cancer worsening (96%) and ORR (95%).

In patients with no expression of PD-L1, IT + IT + CT had the highest probability to be the best treatment in terms of better OS (37%). IT + AA + CT had the highest probability to be the best treatment in terms of better survival without cancer worsening (100%) and ORR (83%).

This study concluded that immunotherapies plus chemotherapy combination was the best first-line treatment for improving overall survival in patients with advanced NSCLC. Immunotherapy plus anti-angiogenic therapy plus chemotherapy combination was the best option for improving survival without cancer progression.

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