Journal Article

Meta-analysis of the Efficacy and Tolerability of Immune Checkpoint Inhibitors Combined With Chemotherapy in First-line Treatment of Small Cell Lung Cancer

Yang, Runxiang, Yang, Fang, Zhang, Aifen, Wu, Jiao, Li, Lu, Liu, Sicheng

2021

Overview

The present study was conducted to evaluate the efficacy and tolerability of using an immune checkpoint inhibitor (ICI; programmed cell death protein 1/ligand 1 [PD-1/PD-L1] inhibitor or cytotoxic T-lymphocyte antigen [CTLA]-4 inhibitor) combined with chemotherapy in the first-line treatment of small cell lung cancer. Potential articles and studies were identified using Web of Science, Cochrane Library, and ClinicalTrials.gov. The end points included overall survival, progression-free survival, objective response rate, and adverse events. Significant heterogeneity was represented by a P value (Ph) of <0.05 or an I2 value of ≥50%, and the random-effects model was applied for pooled analysis. Otherwise, the fixed-effects model was used. Subgroup analysis was performed based on the type of ICI. Potential publication bias was evaluated via funnel plot and the Egger test. Five eligible articles were included. Both overall survival (hazard ratio [HR] = 0.83; 95% CI, 0.75–0.91; P < 0.001) and progression-free survival (HR = 0.80; 95% CI, 0.73–0.86; P < 0.001) were significantly prolonged by joint ICI + chemotherapy treatment. Additionally, the rates of tolerable grade ≥3 adverse events were similar between the ICI combination regimens and conventional chemotherapy (relative risk = 1.05; 95% CI, 0.98–1.12; P = 0.17). Subanalysis demonstrated that patient survival and objective response rate were more efficiently improved with a combination of anti–PD-1/PD-L1, but not anti–CTLA-4, + chemotherapy. Based on data from the available literature, clinical efficacy (as measured by patient survival and objective response rate) was improved with a combination of anti–PD-1/PD-L1 + chemotherapy as first-line treatment compared with chemotherapy alone in patients with small cell lung cancer. •SCLC is a highly aggressive neuroendocrine tumor with limited response to chemotherapy.•Addition of anti-PD-1/PD-L1 to chemotherapy greatly improved survival of SCLC patients.•Anti-PD-1/PD-L1 has been recommended as first-line therapy for patients with ES-SCLC.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Adverse events / Antibodies / anti–CTLA-4 / anti–PD-1/PD-L1 / Apoptosis / Bias / Cancer therapies / Cell death / Chemotherapy / CTLA-4 protein / Cytotoxicity / immune checkpoint inhibitor / Immune checkpoint inhibitors / Immunotherapy / Internal Medicine / Lung cancer / Lymphocytes T / Meta-analysis / Patients / PD-1 protein / PD-L1 protein / Response rates / SCLC / Sensitivity analysis / Small cell lung carcinoma / Software