Comparative efficacy and safety of immunotherapies targeting the PD-1/PD-L1 pathway for previously treated advanced non-small cell lung cancer

A Bayesian network meta-analysis

Abdulaali R. Almutairi, N. Alkhatib, Jennifer Martin, Hani M. Babiker, Linda L Garland, Ali McBride, Ivo L Abraham

Research output: Contribution to journalReview article

Abstract

Background: Two PD-1 (pembrolizumab, nivolumab) and one PD-L1(atezolizumab) inhibitors are approved for previously treated advanced non-small cell lung cancer but have not been compared in head-to-head trials. Method: A network meta-analysis was conducted to compare efficacy/safety of PD-1/PD-L1 inhibitors. Results: In five-trials (including long-term updates) with docetaxel as common comparator there were no differences in OS and PFS between PD-1/PD-L1 inhibitors. Pembrolizumab (odds ratio(OR) = 2.22, 95%CrI = 1.28–3.70) and nivolumab (OR = 1.92, 95%CrI = 1.15–3.23) had higher ORRs than atezolizumab and at PD-L1 expression ≥50% and ≥1%. Probabilistically, pembrolizumab ranked first in OS and ORR, and in OS sub-analyses for adenocarcinoma, EGFR-mutant, ECOG-score-1, male, and age <65 years. Nivolumab ranked first in PFS, and in OS sub-analyses for squamous-cell disease, EGFR-wild-type, and ECOG-score-0. Pembrolizumab and nivolumab ranked the best option for most of adverse events. Conclusion: While pembrolizumab and nivolumab prevailed in rank in OS and ORR benefit, patient characteristics, safety and tolerance should be considered in treatment decision-making.

Original languageEnglish (US)
Pages (from-to)16-25
Number of pages10
JournalCritical Reviews in Oncology/Hematology
Volume142
DOIs
StatePublished - Oct 1 2019

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Non-Small Cell Lung Carcinoma
Immunotherapy
Safety
docetaxel
Odds Ratio
Patient Safety
Decision Making
Adenocarcinoma
Epithelial Cells
Network Meta-Analysis
nivolumab
pembrolizumab
MPDL3280A
Therapeutics

Keywords

  • Atezolizumab
  • Immunotherapy
  • Network meta-analysis
  • Nivolumab
  • Pembrolizumab

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Geriatrics and Gerontology

Cite this

Comparative efficacy and safety of immunotherapies targeting the PD-1/PD-L1 pathway for previously treated advanced non-small cell lung cancer : A Bayesian network meta-analysis. / Almutairi, Abdulaali R.; Alkhatib, N.; Martin, Jennifer; Babiker, Hani M.; Garland, Linda L; McBride, Ali; Abraham, Ivo L.

In: Critical Reviews in Oncology/Hematology, Vol. 142, 01.10.2019, p. 16-25.

Research output: Contribution to journalReview article

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abstract = "Background: Two PD-1 (pembrolizumab, nivolumab) and one PD-L1(atezolizumab) inhibitors are approved for previously treated advanced non-small cell lung cancer but have not been compared in head-to-head trials. Method: A network meta-analysis was conducted to compare efficacy/safety of PD-1/PD-L1 inhibitors. Results: In five-trials (including long-term updates) with docetaxel as common comparator there were no differences in OS and PFS between PD-1/PD-L1 inhibitors. Pembrolizumab (odds ratio(OR) = 2.22, 95{\%}CrI = 1.28–3.70) and nivolumab (OR = 1.92, 95{\%}CrI = 1.15–3.23) had higher ORRs than atezolizumab and at PD-L1 expression ≥50{\%} and ≥1{\%}. Probabilistically, pembrolizumab ranked first in OS and ORR, and in OS sub-analyses for adenocarcinoma, EGFR-mutant, ECOG-score-1, male, and age <65 years. Nivolumab ranked first in PFS, and in OS sub-analyses for squamous-cell disease, EGFR-wild-type, and ECOG-score-0. Pembrolizumab and nivolumab ranked the best option for most of adverse events. Conclusion: While pembrolizumab and nivolumab prevailed in rank in OS and ORR benefit, patient characteristics, safety and tolerance should be considered in treatment decision-making.",
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T1 - Comparative efficacy and safety of immunotherapies targeting the PD-1/PD-L1 pathway for previously treated advanced non-small cell lung cancer

T2 - A Bayesian network meta-analysis

AU - Almutairi, Abdulaali R.

AU - Alkhatib, N.

AU - Martin, Jennifer

AU - Babiker, Hani M.

AU - Garland, Linda L

AU - McBride, Ali

AU - Abraham, Ivo L

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N2 - Background: Two PD-1 (pembrolizumab, nivolumab) and one PD-L1(atezolizumab) inhibitors are approved for previously treated advanced non-small cell lung cancer but have not been compared in head-to-head trials. Method: A network meta-analysis was conducted to compare efficacy/safety of PD-1/PD-L1 inhibitors. Results: In five-trials (including long-term updates) with docetaxel as common comparator there were no differences in OS and PFS between PD-1/PD-L1 inhibitors. Pembrolizumab (odds ratio(OR) = 2.22, 95%CrI = 1.28–3.70) and nivolumab (OR = 1.92, 95%CrI = 1.15–3.23) had higher ORRs than atezolizumab and at PD-L1 expression ≥50% and ≥1%. Probabilistically, pembrolizumab ranked first in OS and ORR, and in OS sub-analyses for adenocarcinoma, EGFR-mutant, ECOG-score-1, male, and age <65 years. Nivolumab ranked first in PFS, and in OS sub-analyses for squamous-cell disease, EGFR-wild-type, and ECOG-score-0. Pembrolizumab and nivolumab ranked the best option for most of adverse events. Conclusion: While pembrolizumab and nivolumab prevailed in rank in OS and ORR benefit, patient characteristics, safety and tolerance should be considered in treatment decision-making.

AB - Background: Two PD-1 (pembrolizumab, nivolumab) and one PD-L1(atezolizumab) inhibitors are approved for previously treated advanced non-small cell lung cancer but have not been compared in head-to-head trials. Method: A network meta-analysis was conducted to compare efficacy/safety of PD-1/PD-L1 inhibitors. Results: In five-trials (including long-term updates) with docetaxel as common comparator there were no differences in OS and PFS between PD-1/PD-L1 inhibitors. Pembrolizumab (odds ratio(OR) = 2.22, 95%CrI = 1.28–3.70) and nivolumab (OR = 1.92, 95%CrI = 1.15–3.23) had higher ORRs than atezolizumab and at PD-L1 expression ≥50% and ≥1%. Probabilistically, pembrolizumab ranked first in OS and ORR, and in OS sub-analyses for adenocarcinoma, EGFR-mutant, ECOG-score-1, male, and age <65 years. Nivolumab ranked first in PFS, and in OS sub-analyses for squamous-cell disease, EGFR-wild-type, and ECOG-score-0. Pembrolizumab and nivolumab ranked the best option for most of adverse events. Conclusion: While pembrolizumab and nivolumab prevailed in rank in OS and ORR benefit, patient characteristics, safety and tolerance should be considered in treatment decision-making.

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KW - Immunotherapy

KW - Network meta-analysis

KW - Nivolumab

KW - Pembrolizumab

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