Abstract 620P
Background
Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, arising from the epithelial cells of the lung. The prognosis of lung cancer remains poor, with a 5-year survival rate approximately at 15%. Several immunotherapy has been approved by FDA and has demonstrated clinical activity in NSCLC. Pembrolizumab, a humanized immunoglobulin G4 monoclonal antibody, is highly selective for programmed cell death protein 1 (PD-1). To improve outcomes, efforts have been done by combining immunotherapy with radiotherapy (RT). Therefore, this meta-analysis aims to analyse the potential combination of pembrolizumab with radiotherapy (RT) compared with pembrolizumab alone for NSCLC.
Methods
Literature search was conducted from PubMed, PMC, Google Scholar and Science Direct with keywords include “Pembrolizumab” and “Radiotherapy” or “Radiation therapy” and “Non-small cell lung cancer”. Newcastle-Ottawa Scale is used to appraise each study, Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) to assess this review and funnel plot to detect publication bias. Generic inverse variance method were used to pool hazard ratio (HR) obtained from log-rank, univariate and multivariate cox regression of overall survival (OS) and progression-free survival (PFS).
Results
We included 2 randomized controlled trials (RCT) with 6 cohorts with a combined total of 1,087 patients. All studies were of high quality, minimal publication bias and GRADE shows to be moderate certainty. Patients receiving pembrolizumab with radiotherapy (RT) in log rank analysis have higher overall survival (OS) (HR 0.68; 95% CI 0.57–0.81; p < 0.0001) and progression-free survival (PFS) (HR 0.63 95% CI 0.48–0.84; p = 0.002). Similar results also showed in univariate analysis of OS (HR 0.76; 95% CI, 0.58–1.00; p = 0.005) and PFS (HR 0.60; 95% CI, 0.48–0.75; p < 0.0001), and multivariate analysis of OS (HR 0.79; 95% CI, 0.68–0.92; p = 0.002) and PFS (HR 0.69; 95% CI, 0.59–0.81; p < 0.0001).
Conclusions
Pembrolizumab with radiotherapy is found to be more effective therapy for the management in non-small cell lung cancer when compared to pembrolizumab alone. However, further RCTs are required to confirm these findings.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
K. Wibowo.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.