Efficacy of anti-PD-1/PD-L1 inhibitors versus docetaxel in the treatment of non-small cell lung cancer: a systematic review and meta-analysis

doi:10.3877/cma.j.issn.2095-8773.2021.04.07

Abstract

Abstract:

Objective

To compare the efficacy of anti-PD-1/PD-L1 inhibitors against docetaxel in the treatment of advanced non-small cell lung cancer (NSCLC) by meta-analysis.

Methods

The randomized controlled trials (RCTs) of anti-PD-1/PD-L1 inhibitors and docetaxel in the treatment of NSCLC published until May 2021 were collected via searching CNKI, Wanfang, VIP, CBM, PubMed, EMBASE, Cochrane Library and Web of Science databases. Two reviewers independently conducted literature retrieval, screened literature and extracted data according to unified quality criteria. Then RevMan5.3 was used to perform statistical analysis and heterogeneity test. Any disputes were resolved through discussion.

Results

A total of 12 RCTs were included, including 4 684 patients treated with anti-PD-1/PD-L1 inhibitors and 4 610 patients treated with docetaxel. Treatments with anti-PD-1/PD-L1 inhibitors resulted in longer overall survival (HR=0.73, 95%CI: 0.69-0.77, P<0.00001) and progression-free survival (HR=0.88, 95%CI: 0.80-0.96, P=0.004) when compared with docetaxel, and their clinical effect is better.

Conclusion

Compared with docetaxel, anti-PD-1/PD-L1 inhibitors improves clinical efficacy. This therapy could be a promising treatment for patients with advanced NSCLC. The results still need to be confirmed by a multi-center, large sample, and high-quality research.

Key words: Anti-PD-1/PD-L1 inhibitors, Docetaxel, Non-small cell lung cancer, Meta-analysis

Gang Jin, Keying Yao, Xingwei Shen, Long Ma, Zijiang Zhu. Efficacy of anti-PD-1/PD-L1 inhibitors versus docetaxel in the treatment of non-small cell lung cancer: a systematic review and meta-analysis[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2021, 08(04): 239-246.

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References 29

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第一作者	发表时间	患者数	治疗方式	疾病分期	临床试验分期	随访时间（月）	组织类型	OS，HR（95%CI）	PFS，HR（95%CI）
Borghaei等^[11]	2015	292	帕博利珠单抗200 mg，3周1次	ⅢB或Ⅳ	3	12.2	非鳞状NSCLC	0.73（0.59~0.89）	0.92（0.77~1.10）
Borghaei等^[11]	2015	290	铂基化疗	ⅢB或Ⅳ	3	9.4	非鳞状NSCLC	0.73（0.59~0.89）	0.92（0.77~1.10）
Brahmer等^[12]	2015	135	纳武利尤单抗3 mg/kg，2周1次	ⅢB或Ⅳ	3	9.2	鳞状NSCLC	0.59（0.44~0.79）	0.62（0.47~0.81）
Brahmer等^[12]	2015	137	多西他赛75 mg/m²，3周1次	ⅢB或Ⅳ	3	6	鳞状NSCLC	0.59（0.44~0.79）	0.62（0.47~0.81）
Fehrenbacher等^[13]	2016	144	阿替利珠单抗1 200 mg，3周1次	/	2	14.8	NSCLC	0.73（0.53~0.99）	0.94（0.72~1.23）
Fehrenbacher等^[13]	2016	143	多西他赛75 mg/m²，3周1次	/	2	15.7	NSCLC	0.73（0.53~0.99）	0.94（0.72~1.23）
Herbst等^[14]	2016	346	帕博利珠单抗10 mg/kg，2周1次	/	3	13.1	NSCLC	0.61（0.49~0.76）	0.79（0.66~0.95）
Herbst等^[14]	2016	343	多西他赛75 mg/m²，3周1次	/	3	13.1	NSCLC	0.61（0.49~0.76）	0.79（0.66~0.95）
Rittmeyer等^[15]	2017	425	阿替利珠单抗1 200 mg，3周1次	ⅢB或Ⅳ	3	21	NSCLC	0.73（0.62~0.87）	0.95（0.82~1.10）
Rittmeyer等^[15]	2017	425	多西他赛75 mg/m²，3周1次	ⅢB或Ⅳ	3	21	NSCLC	0.73（0.62~0.87）	0.95（0.82~1.10）
Barlesi等^[16]	2018	396	阿维单抗10 mg/kg，2周1次	ⅢB或Ⅳ	3	18.9	NSCLC	0.90（0.72~1.12）	1.01（0.80~1.28）
Barlesi等^[16]	2018	396	多西他赛75 mg/m²，3周1次	ⅢB或Ⅳ	3	17.8	NSCLC	0.90（0.72~1.12）	1.01（0.80~1.28）
Fehrenbacher等^[17]	2018	613	阿替利珠单抗1 200 mg，3周1次	/	3	28	NSCLC	0.80（0.70~0.92）	0.96（0.85~1.08）
Fehrenbacher等^[17]	2018	612	多西他赛75 mg/m²，3周1次	/	3	28	NSCLC	0.80（0.70~0.92）	0.96（0.85~1.08）
Vokes等^[18]	2018	427	纳武利尤单抗3 mg/kg，2周1次	ⅢB或Ⅳ	3	40.3	NSCLC	0.70（0.61~0.81）	0.80（0.69~0.92）
Vokes等^[18]	2018	427	多西他赛75 mg/m²，3周1次	ⅢB或Ⅳ	3	40.3	NSCLC	0.70（0.61~0.81）	0.80（0.69~0.92）
von Pawel等^[19]	2019	398	阿替利珠单抗1 200 mg，3周1次	/	3	28	NSCLC	0.75（0.64~0.89）	/
von Pawel等^[19]	2019	376	多西他赛75 mg/m²，3周1次	/	3	28	NSCLC	0.75（0.64~0.89）	/
Horn等^[20]	2017	427	纳武利尤单抗3 mg/kg，2周1次	ⅢB或Ⅳ	3	24.2	NSCLC	0.72（0.62~0.84）	/
Horn等^[20]	2017	427	多西他赛75 mg/m²，3周1次	ⅢB或Ⅳ	3	24.2	NSCLC	0.72（0.62~0.84）	/
Barlesi等^[21]	2019	312	帕博利珠单抗2 mg/kg，3周1次	/	2/3	12	NSCLC	/	/
Barlesi等^[21]	2019	266	多西他赛75 mg/m²，3周1次	/	2/3	12	NSCLC	/	/
Bordoni等^[22]	2018	425	阿替利珠单抗1 200 mg，3周1次	/	3	12	鳞状NSCLC	0.73（0.62~0.87）	/
Bordoni等^[22]	2018	425	多西他赛75 mg/m²，3周1次	/	3	12	鳞状NSCLC	0.73（0.62~0.87）	/

第一作者	发表时间	患者数	治疗方式	疾病分期	临床试验分期	随访时间（月）	组织类型	OS，HR（95%CI）	PFS，HR（95%CI）
Borghaei等^[11]	2015	292	帕博利珠单抗200 mg，3周1次	ⅢB或Ⅳ	3	12.2	非鳞状NSCLC	0.73（0.59~0.89）	0.92（0.77~1.10）
Borghaei等^[11]	2015	290	铂基化疗	ⅢB或Ⅳ	3	9.4	非鳞状NSCLC	0.73（0.59~0.89）	0.92（0.77~1.10）
Brahmer等^[12]	2015	135	纳武利尤单抗3 mg/kg，2周1次	ⅢB或Ⅳ	3	9.2	鳞状NSCLC	0.59（0.44~0.79）	0.62（0.47~0.81）
Brahmer等^[12]	2015	137	多西他赛75 mg/m²，3周1次	ⅢB或Ⅳ	3	6	鳞状NSCLC	0.59（0.44~0.79）	0.62（0.47~0.81）
Fehrenbacher等^[13]	2016	144	阿替利珠单抗1 200 mg，3周1次	/	2	14.8	NSCLC	0.73（0.53~0.99）	0.94（0.72~1.23）
Fehrenbacher等^[13]	2016	143	多西他赛75 mg/m²，3周1次	/	2	15.7	NSCLC	0.73（0.53~0.99）	0.94（0.72~1.23）
Herbst等^[14]	2016	346	帕博利珠单抗10 mg/kg，2周1次	/	3	13.1	NSCLC	0.61（0.49~0.76）	0.79（0.66~0.95）
Herbst等^[14]	2016	343	多西他赛75 mg/m²，3周1次	/	3	13.1	NSCLC	0.61（0.49~0.76）	0.79（0.66~0.95）
Rittmeyer等^[15]	2017	425	阿替利珠单抗1 200 mg，3周1次	ⅢB或Ⅳ	3	21	NSCLC	0.73（0.62~0.87）	0.95（0.82~1.10）
Rittmeyer等^[15]	2017	425	多西他赛75 mg/m²，3周1次	ⅢB或Ⅳ	3	21	NSCLC	0.73（0.62~0.87）	0.95（0.82~1.10）
Barlesi等^[16]	2018	396	阿维单抗10 mg/kg，2周1次	ⅢB或Ⅳ	3	18.9	NSCLC	0.90（0.72~1.12）	1.01（0.80~1.28）
Barlesi等^[16]	2018	396	多西他赛75 mg/m²，3周1次	ⅢB或Ⅳ	3	17.8	NSCLC	0.90（0.72~1.12）	1.01（0.80~1.28）
Fehrenbacher等^[17]	2018	613	阿替利珠单抗1 200 mg，3周1次	/	3	28	NSCLC	0.80（0.70~0.92）	0.96（0.85~1.08）
Fehrenbacher等^[17]	2018	612	多西他赛75 mg/m²，3周1次	/	3	28	NSCLC	0.80（0.70~0.92）	0.96（0.85~1.08）
Vokes等^[18]	2018	427	纳武利尤单抗3 mg/kg，2周1次	ⅢB或Ⅳ	3	40.3	NSCLC	0.70（0.61~0.81）	0.80（0.69~0.92）
Vokes等^[18]	2018	427	多西他赛75 mg/m²，3周1次	ⅢB或Ⅳ	3	40.3	NSCLC	0.70（0.61~0.81）	0.80（0.69~0.92）
von Pawel等^[19]	2019	398	阿替利珠单抗1 200 mg，3周1次	/	3	28	NSCLC	0.75（0.64~0.89）	/
von Pawel等^[19]	2019	376	多西他赛75 mg/m²，3周1次	/	3	28	NSCLC	0.75（0.64~0.89）	/
Horn等^[20]	2017	427	纳武利尤单抗3 mg/kg，2周1次	ⅢB或Ⅳ	3	24.2	NSCLC	0.72（0.62~0.84）	/
Horn等^[20]	2017	427	多西他赛75 mg/m²，3周1次	ⅢB或Ⅳ	3	24.2	NSCLC	0.72（0.62~0.84）	/
Barlesi等^[21]	2019	312	帕博利珠单抗2 mg/kg，3周1次	/	2/3	12	NSCLC	/	/
Barlesi等^[21]	2019	266	多西他赛75 mg/m²，3周1次	/	2/3	12	NSCLC	/	/
Bordoni等^[22]	2018	425	阿替利珠单抗1 200 mg，3周1次	/	3	12	鳞状NSCLC	0.73（0.62~0.87）	/
Bordoni等^[22]	2018	425	多西他赛75 mg/m²，3周1次	/	3	12	鳞状NSCLC	0.73（0.62~0.87）	/

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