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Poster display - Cocktail

866 - PD-(L)1 Inhibitors VS. Chemotherapy VS. Their Combination in Front-line Treatment of NSCLC

Date

24 Nov 2018

Session

Poster display - Cocktail

Presenters

Hengrui Liang

Citation

Annals of Oncology (2018) 29 (suppl_9): ix150-ix169. 10.1093/annonc/mdy425

Authors

H. Liang, D. Chen, Z. Liu, J. He, W. Liang

Author affiliations

  • Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, 510000 - Guangzhou/CN
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Resources

Abstract 866

Background

This indirect comparison and meta-analysis was conducted to comprehensively compare the therapeutic effects of PD-1/L1 antibodies, chemotherapy or their combination as first-line treatments for NSCLC.

Methods

RCTs that compared the efficacy of first-line PD-1/L1 inhibitors (I) with chemotherapy (C), or with their combination (I+C) for NSCLC patients were comprehensively searched. HR of PFS and OS and their 95% CI were pooled. Subgroup analyses were conducted according to different PD-L1 expression. Traditional meta-analyses were conducted to compare the efficacy of I vs. C, or I+C vs. C. Indirect treatment comparisons (ITCs) were then conducted to compare I+C and I.

Results

A total of 9 studies involving 6,056 patients were included. The combined ORRs of I, C and I+C were 32.0%, 31.0% and 50.6%. The combined 9m-PFS rate were 37.9%, 26.6% and 43.3%, and 2y-OS rate were 39.0%, 34.2% and 47.0% in I, C and I+C arm. Overall, I showed no significant difference with C either according to PFS (HR 0.90, 0.65-1.24) or OS (HR 0.84, 0.64-1.09), while I+C was significantly superior to C both in PFS (HR 0.63, 0.56-0.71) and OS (HR 0.68, 0.53-0.88). In indirect comparison, I+C showed advantages than I in PFS (HR 0.70, 0.50-0.99) but not OS (HR 0.81, 0.56-1.16). In PD-L1≥50% population, I had better OS than C (HR 0.71, 0.59-0.86), and I+C also had better OS than C (HR 0.57, 0.44-0.73). In indirect analysis, I+C was superior to I in terms of PFS (HR 0.50, 0.32-0.77), but not OS (HR 0.8, 0.58 to 1.10). In PD-L1 positive subgroup, I was similar with C regarding OS (HR 0.92, 0.70-1.22) and PFS (HR 1.09, 0.98-1.21), but I+C had longer PFS in this population than I (HR 0.47, 0.38 to 0.58). In PD-L1 negative subgroup, adding I to C was significantly beneficial both in OS (HR 0.76, 0.64-0.91) and PFS (HR 0.76, 0.67-0.86).

Conclusions

Single agent PD-1/L1 inhibitor was preferable only in PD-L1 high expression population but remained optional in all PD-L1 positive patients. Adding chemotherapy to PD-1/L1 inhibitors provided additional benefit not only in low but also in high PD-L1 expression patients. PD-1/L1 inhibitors plus chemotherapy was better than chemotherapy alone in PD-L1 negative patients. In all, we suggest combination regimen as first-line treatment for NSCLC regardless of PD-L1 expression.

Editorial acknowledgement

Clinical trial identification

Legal entity responsible for the study

The First Affiliated Hospital of Guangzhou Medical University.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.

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