Abstract 28P
Background
PD-(L)1 inhibitors have emerged as a promising alternative to chemotherapy for the treatment of non-small cell lung cancer (NSCLC). However, the impact of these treatments based on sex remains poorly understood. This meta-analysis assesses the difference in efficacy between men and women treated with PD-(L)1 inhibitors monotherapy compared to chemotherapy.
Methods
We analyzed 13 phase III studies (7 in first-line and 6 in second-line) comparing PD-(L)1 inhibitors (nivolumab, pembrolizumab, atezolizumab, durvalumab, cemiplimab, avelumab and tislelizumab) to chemotherapy in patients with NSCLC. The data included a total of 8,350 patients, with 5,766 men and 2,584 women. The primary objective was to compare overall survival (OS) between the two sexes, measured by the hazard ratio (HR) and corresponding confidence intervals (CI). A random-effects model was used to calculate combined HRs.
Results
In men, PD-(L)1 inhibitors significantly improved OS compared to chemotherapy, with an HR of 0.71 (95% CI: 0.65–0.79). In women, although PD-(L)1 inhibitors also showed superiority over chemotherapy, the effect was less pronounced, with an HR of 0.83 (95% CI: 0.75–0.93). The analysis of the interaction between sex and treatment efficacy revealed a statistically significant difference (p=0.03). This difference was more pronounced for patients with NSCLC PD-L1 TPS >50% especially in first-line. For progression-free survival (PFS), the HRs were 0.68 (95% CI: 0.56–0.83) in men and 1.07 (95% CI: 0.88–1.31) in women, with a significant difference between the two sexes (p=0.002).
Conclusions
This meta-analysis highlights a sex-based difference in the efficacy of PD-(L)1 inhibitors in NSCLC. Although both sexes benefit from these treatments, men appear to derive greater advantages in terms of OS and PFS. These findings suggest that differentiated therapeutic strategies may be considered to improve outcomes in women with NSCLC. The final results of this updated meta-analysis, incorporating recent studies, will be presented at the meeting, including meta-analysis of first-line studies comparing chemotherapy + anti-PD(L)1 to chemotherapy alone.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.