ABSTRACT
Background
We intended to compare and grade the proposed immune treating strategies for non-small cell lung cancer (NSCLC) with negative Programmed Cell Death Ligand 1(PD-L1).
Methods
We compared the efficacy of single immune checkpoint inhibitor (ICI), single ICI plus chemotherapy, and doublet ICIs with chemotherapy alone, as well as single ICI plus radiotherapy with single ICI for negative PD-L1 (<1%) NSCLC patients. Hazard Ratio (HR) and 95% confidence interval (CI) of progression-free survival (PFS) and overall survival (OS) were used as outcomes.
Results
We included 23 randomized control trials with 4665 patients. Compared with chemotherapy alone, single ICI, single ICI plus chemotherapy and doublet ICIs all showed a better OS (0.84 [0.71, 0.99] ; 0.77 [0.69, 0.85] ; 0.64 [0.53, 0.77])), while single ICI plus chemotherapy and doublet ICIs showed a better PFS (0.68 [0.61, 0.75] ; 0.69 [0.56, 0.85]). Additionally, single ICI plus radiotherapy obtained a greater pooled PFS (0.49 [0.28–0.87]) than single ICI.
Conclusions
Both single ICI plus chemotherapy and doublet ICIs were probably better treatment decisions than chemotherapy alone for negative PD-L1 NSCLC patients. Also, single ICI plus radiotherapy carved out a new strategy.
Article highlights
Both doublet ICIs and single-agent ICI plus chemotherapy showed a better PFS and OS than chemotherapy for negative PD-L1 NSCLC.
They represented a better PFS for single-agent ICI than chemotherapy in NSCLC without PD-L1 expression, but no statistically significant result in OS.
The addition of radiotherapy to single-agent ICI could promote a better PFS for negative PD-L1 NSCLC.
Declaration of interest
The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
Reviewer disclosures
Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.
Author contributions
Study design: K Ding, Y Zhang and M Yi, data collection: K Ding, H Liang, M Yi, Z Li and Y Zhang, data analysis: K Ding, M Yi, H Liang and Y Zhang, writing: K Ding, M Yi, H Liang, Z Li and Y Zhang, funding: M Yi and Y Zhang, administration: M Yi and Y Zhang. All authors agree for the final version of the manuscript to be published.
Supplementary material
Supplemental data for this article can be accessed online at https://doi.org/10.1080/1744666X.2022.2088510