![]() Whereas for patients with PD-L1-intermediate expression (1%≤ PD-L1 < 50%), ICIs + chemotherapy is generally considered the best option. Ĭurrently, evidence suggests that the OS benefit from monotherapy was mainly observed in patients with high PD-L1 expression (PD-L1 TPS≥50%) in first-line therapies for advanced NSCLC, such as pembrolizumab in KEYNOTE 024, atezolizumab in IMpower 110 or cemiplimab in EMPOWER-Lung. ICI based therapies have been recommended as standard first-line regimens in metastatic or advanced NSCLC patients without oncogenic drivers, as monotherapy or combined with chemotherapy according to PD-L1 expression. Immune checkpoint inhibitors (ICIs) including anti‒programmed death-1 (PD-1) monoclonal antibody and PD-L1 have greatly changed the treatment pattern of advanced and metastatic NSCLC. Non-small cell lung cancer (NSCLC) accounts for about 80–90% of lung cancer cases. Lung cancer remains the leading cause of cancer mortality worldwide, which caused 1.8 million deaths in 2020. With the marketing of new ICI regiments and increasing numbers of trials published and long-term outcomes updated recently, we conducted an updated network meta-analysis to compare the treatment efficacy of different first-lines regimens for advanced NSCLC patients without oncogenic driver mutations. However, there remains considerable debate about the best therapeutic model (i.e., immunotherapy as single agent or in combination, and how to choose optimal combination therapy), and the potential differences in tolerability between individual treatment strategies. Increasing treatment options may reshape the first-line ICI interventions for advanced NSCLC patients. Moreover, at WCLC &ESMO 2021, data of several new first-line phase 3 clinical trials assessed ICI therapy have been published as abstracts. At ASCO 2020, impressive long-term PFS and OS data were published with the updated final analysis of KEYNOTE-189 and CheckMate 227. Recently, a series of phase 3 trials evaluated the efficacy of new anti-PD-1 antibodies have been published, and new combined ICIs approved indications for advanced NSCLC. The funders of this work had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Ĭompeting interests: the authors declare that they have no conflict of interest. ZR2021MH006), and the corresponding author doctor LY received this award. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.ĭata Availability: The relevant data are within the Supporting Information files.įunding: This work was supported by Natural Science Foundation of Shandong Province (No. Received: SeptemAccepted: MaPublished: April 18, 2023Ĭopyright: © 2023 Liu et al. PLoS ONE 18(4):Įditor: Rama Krishna Kancha, Osmania University, Hyderabad, India, INDIA (2023) Identifying optimal first-line immune checkpoint inhibitors based regiments for advanced non-small cell lung cancer without oncogenic driver mutations: A systematic review and network meta-analysis. For more than 2 years follow-up, the atezolizumab, pembrolizumab, nivolumab and durvalumab containing ICI therapy all provide a durable long-term OS benefit over chemotherapy and BEV + chemotherapy.Ĭitation: Liu T, Wu S, Fang W, Li H, Su L, Qi G, et al. In terms of OS for patients with non-squamous NSCLC, pembrolizumab containing CIT was associated with a median rank of the best regimens, and followed by Atezolizumab+BEV based CIT while for OS in patients with squamous NSCLC, Cemiplimab and sintilimab based CIT were the most effective regimens. In comprehensive terms of PFS, chemoimmunotherapy (CIT) were significantly more effective than ICI monotherapy and doublet ICIs. ![]() A series of ICI regiments (including ICI plus chemotherapy), ICI monotherapy, doublet ICIs, doublet ICIs plus chemotherapy) emerged, and showed significant PFS and OS benefit than chemotherapy and chemotherapy + bevacizumab (BEV) for advanced wild-type NSCLC. Thirty-two double-blind RCTs were included, involving 18,656 patients assigned to 22 ICI-based first-line regimens.
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