Pembrolizumab plus chemotherapy demonstrated the greatest survival benefit compared with other immune checkpoint inhibitors (ICIs) across all PD-L1 expression levels in the first-line treatment of advanced non-small cell lung cancer (NSCLC), according to a meta-analysis presented at the IASLC 2019 World Conference on Lung Cancer.

Randomized clinical trials evaluating first-line ICI alone or in combination with chemotherapy in advanced NSCLC were collected from PubMed and conference abstracts for a head-to-head network meta-analysis. Investigators compared overall survival (OS) among the different ICIs and computed treatment rankings based on their relative effects at different PD-L1 expression levels.

After analyzing 7 trials that fit the inclusion criteria, researchers found that treatment with pembrolizumab plus chemotherapy showed the greatest OS benefit (HR ≤0.60) among all ICIs, with >99% probability to be better than standard chemotherapy across all PD-L1 expression levels. For PD-L1 expression ≥50%, both atezolizumab plus chemotherapy and pembrolizumab monotherapy were associated with >95% probability to outperform standard chemotherapy. 

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Monotherapy with nivolumab demonstrated little to no benefit across PD-L1 categories. A hazard ratio of 0.76 (95% CI, 0.48-1.19) for PD-L1 expression ≥50% was found when pembrolizumab plus chemotherapy was compared to pembrolizumab alone.

“Pembrolizumab [plus] chemotherapy demonstrated best survival benefit compared to other ICIs across all PD-L1 expression levels in the first-line treatment of advanced NSCLC,” the authors concluded.

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Reference

San Tan P, Nazareth Aguiar Junior P, Husnain M, et al. First-line immune checkpoint inhibitors in advanced non-small cell lung cancer (NSCLC) – a network meta-analysis by PD-L1. Presented at: The IASLC 2019 World Conference on Lung Cancer (WCLC) of the International Association for the Study of Lung Cancer; September 7-10, 2019; Barcelona Spain. Abstract P1.04-67.