Efficacy comparison of immune treating strategies for NSCLC patients with negative PD-L1 expression

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.

KEYWORDS:

• Immune checkpoint inhibitors
• negative PD-L1 expression
• NSCLC
• overall survival
• Progression-free survival

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

Additional information

Funding

This research was supported by the Hunan Provincial Natural Science Foundation of China (No. 2020JJ5951, No. 2021JJ80079), the Youth Science Foundation of Xiangya Hospital (No. 2019Q17), the Degree & Postgraduate Education Reform Project of Central South University (No. 2021YJSKSA10), the Undergraduate Education Reform Project of Central South University (No. 2021CG065, No. 2021CG068) and the Research Project of Laboratory Construction and Management of Central South University (No. 202120).