Journal of Shandong University (Health Sciences) ›› 2022, Vol. 60 ›› Issue (7): 74-82.doi: 10.6040/j.issn.1671-7554.0.2022.0238

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A network meta-analysis of first-line treatment options for patients with advanced driver-gene wild-type and PD-L1 negative non-squamous non-small cell lung cancer

QIN Jing, YANG Fei, CHEN Qian, XIA Handai, LIU Yanguo, WANG Xiuwen   

  1. Department of Medical Oncology, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China
  • Published:2022-07-27

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Abstract: Objective A network meta-analysis was performed to compare the efficacy and safety of first-line treatment regimens of advanced driver-gene wild-type and programmed death-ligand 1(PD-L1)negative non-squamous non-small cell lung cancer(NSCLC). Methods First-line treatment trials of advanced driver-gene wild-type non-squamous NSCLC were searched in PubMed, Cochrane Library, Embase database and ClinicalTrials.gov website. Randomized controlled trials(RCTs)comparing first-line treatment regimens including chemotherapy, immune checkpoint inhibitors(ICIs), antiangiogenic therapy and their combinations were included. StataMP 16.0 and R 4.1.0 were used for data analysis. Results A total of 10 RCTs were included, involving 5,731 patients and 10 treatment regimens. There was no statistically significant difference in overall survival(OS)and progression-free survival(PFS)among the treatment regimens(P>0.05). The regimen of pembrolizumab + chemotherapy had the longest OS, and the regimen of nivolumab+bevacizumab+chemotherapy had the longest PFS. The objective response rates(ORR)of atezolizumab+ chemotherapy and pembrolizumab+chemotherapy were higher than that of chemotherapy(OR=1.66, 95%CI: 1.07-2.59; OR=2.68, 95%CI: 1.40-5.11). In terms of allgrade adverse events(AEs), camrelizumab + chemotherapy was higher(AEs)than chemotherapy and sintilimab + chemotherapy(OR=1.05, 95%CI: 1.01-1.08; OR=1.05, 95%CI: 1.01-1.09). In terms of ≥3 grade AEs, there was no statistically significant difference among the treatment regimens(P>0.05). Conclusion For patients with advanced driver-gene wild-type PD-L1 negative non-squamous NSCLC, there was no significant difference in survival benefits among the existing first-line treatment regimens. The combination of immunotherapy and chemotherapy was more effective, but the adverse events were also more significant. A reasonable treatment regimen should be selected according to the individual conditions.

Key words: Non-small cell lung cancer, Network meta-analysis, Programmed death-ligand 1, Chemotherapy, Antiangiogenic therapy, Immunotherapy

CLC Number: 

  • R734.2
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