Personalized PD-1/PD-L1 inhibitor therapy for advanced non small cell lung cancer beyond first line; a meta-analysis of potential predictive factors

Background

Non small cell lung cancer (NSCLC) comprises the majority of primary lung cancers and it is usually fatal in its advanced stages. the objective of this analysis is to assess the potential clinical and biological predictive markers of survival in pretreated advanced NSCLC patients treated with the three PD-1/PD-L1 inhibitors (nivolumab, pembrolizumab, atezolizumab).

Methods

MEDLINE and EMBASE databases have been searched. Randomized clinical trials comparing the three PD-1 /PD-L1 inhibitors versus other treatments for the management of Pretreated advanced NSCLC were evaluated.

Results

Four randomized trials with 2163 were included. Two studies evaluated nivolumab versus docetaxel, one study evaluated pembrolizumab versus docetaxel and one study evaluated atezolizumab versus docetaxel. Comparing EGFR mutant to wild type disease, patients with EGFR wild type disease derive greater benefit from PD-1/PD-L1 inhibitors. The pooled HR for death for patients with mutant disease was 1.05 [95% CI: 0.69, 1.60; P= 0.81]; while pooled HR for death for patients with wild type disease was 0.66 [95% CI: 0.57, 0.77; P 

Conclusions

Further controlled studies are required to properly confirm the predictive value of PD-L1 and EGFR statuses in this setting as well as evaluate more clearly the predictive role of smoking, KRAS status, ALK status and CNS metastasis.

Clinical trial identification

Legal entity responsible for the study

N/A

Funding

Ain Shams University

Disclosure

All authors have declared no conflicts of interest.