Nivolumab plus ipilimumab versus pembrolizumab as chemotherapy‐free, first‐line treatment for PD‐L1‐positive non‐small cell lung cancer
Autor: | Bei Zhang, Yixin Zhou, Shaodong Hong, Yanyu Cai, Yaqiong Zhang, Hui Yu, Li Zhang, Guifang Guo, Xiuyu Cai |
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Rok vydání: | 2020 |
Předmět: |
non‐small cell lung cancer
0301 basic medicine Oncology medicine.medical_specialty programmed cell death‐ligand 1 medicine.medical_treatment Medicine (miscellaneous) Ipilimumab Pembrolizumab 03 medical and health sciences 0302 clinical medicine Internal medicine medicine ipilimumab Adverse effect Lung cancer Research Articles nivolumab lcsh:R5-920 Chemotherapy business.industry Hazard ratio medicine.disease 030104 developmental biology 030220 oncology & carcinogenesis Relative risk Molecular Medicine pembrolizumab Nivolumab lcsh:Medicine (General) business Research Article medicine.drug |
Zdroj: | Clinical and Translational Medicine, Vol 10, Iss 1, Pp 107-115 (2020) Clinical and Translational Medicine |
ISSN: | 2001-1326 |
Popis: | Background Nivolumab plus ipilimumab (N‐I) or pembrolizumab (PEM) is associated with survival improvement as chemotherapy‐free, first‐line treatment for patients with advanced non‐small cell lung carcinoma (NSCLC) and positive programmed cell death ligand 1 (PD‐L1). However, no direct comparison data exist between these two regimens to inform clinical decisions. Therefore, we performed indirect comparison for N‐I versus PEM using frequentist methods. Results Three randomized trials (KEYNOTE‐024, KEYNOTE‐042, and CheckMate 227) involving 2372 patients were included. For patients with tumor PD‐L1 level of ≥1%, pooled meta‐analyses showed that both N‐I and PEM improved overall survival (OS) relative to chemotherapy (N‐I: hazard ratio [HR] 0.82, 95% CI 0.69‐0.97; PEM: HR 0.81, 95% CI 0.71‐0.93); whereas only N‐I significantly improved progression‐free survival (PFS) (N‐I: HR 0.79, 95% CI 0.65‐0.96; PEM: HR 1.07, 95% CI 0.94‐1.21). Neither N‐I nor PEM was associated with improved objective response rate (ORR) compared with chemotherapy (N‐I: relative risk [RR] 1.20, 95% CI 0.98‐1.46; PEM: RR 1.03, 95% CI 0.86‐1.23). Indirect comparisons showed that N‐I was associated with longer PFS than PEM (HR 0.77, 95% CI 0.62‐0.95). However, N‐I was not superior to PEM in terms of OS (HR 0.98, 95% CI 0.77‐1.24) and ORR (RR 1.17, 95% CI 0.89‐1.52). N‐I showed a less favorable toxicity profile relative to PEM (all grade adverse events: RR 1.28, 95% CI 1.17‐1.40). Conclusions N‐I and PEM provide comparable OS benefit for PD‐L1‐positive NSCLC. N‐I further improves PFS relative to PEM but at meaningful cost of toxicities. |
Databáze: | OpenAIRE |
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