2023 World Conference on Lung Cancer (Posters)-EP11.03. Outcomes of Immunotherapy vs Chemotherapy as First-Line Treatment in Advanced NSCLC: A Meta-analysis of Randomized Clinical Trials

EP11.03. Outcomes of Immunotherapy vs Chemotherapy as First-Line Treatment in Advanced NSCLC: A Meta-analysis of Randomized Clinical Trials - PDF(Slides)

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A meta-analysis was conducted to evaluate the benefit of immune checkpoint inhibitors (ICIs) compared to standard-of-care treatment for advanced-stage lung cancer. The analysis included 22 randomized controlled trials (RCTs) and found that ICIs improved overall survival (OS) in patients with non-squamous and squamous histologies, as well as both PD-L1 negative and positive patients. The pooled hazard ratios (HRs) were 0.78 for non-squamous histology, 0.76 for squamous histology, and 0.78 for both histologies. Sensitivity analyses did not reveal any changes in the pooled results.<br /><br />However, it was observed that patients with mutations in the STK11 or KEAP1 genes did not benefit from single-agent ICIs plus chemotherapy (CMT). The pooled HRs for these patients were 0.81 for STK11 mutation and 0.97 for KEAP1 mutation. On the other hand, combination therapy with doublet ICIs showed improved OS in patients with both STK11 and KEAP1 mutations, with pooled HRs of 0.72 and 0.35, respectively.<br /><br />The study used data from CENTRAL, Embase, and Medline databases, and included RCTs that reported OS in patients with advanced non-small cell lung cancer (NSCLC). The eligible studies had at least one arm receiving ICIs with or without CMT, and one arm receiving CMT alone as first-line therapy. The data were stratified based on histology, PD-L1 expression, and the presence of KRAS, STK11, and KEAP1 gene mutations. The pooled HRs were determined using the generic-inverse variance method.<br /><br />In conclusion, the meta-analysis showed that CMT plus ICI improved OS in patients with advanced NSCLC, regardless of PD-L1 status and histology. However, the presence of STK11 or KEAP1 mutations indicated resistance to single-agent ICI plus CMT, which could be overcome by doublet ICI regimens.

Asset Subtitle

Ben Ponvilawan

Meta Tag

Speaker Ben Ponvilawan

Topic Metastatic NSCLC: Immunotherapy - Retrospective

Keywords

meta-analysis

immune checkpoint inhibitors

advanced-stage lung cancer

overall survival

pooled hazard ratios

STK11 mutation

KEAP1 mutation

combination therapy

non-small cell lung cancer

doublet ICI regimens