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Authors Peng M, Li X, Lei G, Weng YM, Hu MX, Song QB
Received 17 June 2018
Accepted for publication 23 August 2018
Published 24 October 2018 Volume 2018:11 Pages 7369—7383
DOI https://doi.org/10.2147/OTT.S177318
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Amy Norman
Peer reviewer comments 2
Editor who approved publication: Dr Federico Perche
Abstract: The value of immune checkpoint inhibitor (ICI) combination therapy
for patients with lung cancer remains unclear. We conducted a meta-analysis
using PubMed, Embase, and ClinicalTrials.gov databases to identify eligible
randomized controlled trials (RCTs) that might provide a reference for clinical
practice. The selection criteria were defined according to the population,
intervention, comparison, outcome and study design (PICOS) framework. In all,
12 RCTs with 5,989 patients were included in this meta-analysis. Our results
showed that ICI combination therapy was significantly associated with the
improvement of overall response rate (ORR) (RR =1.44 [95% CI 1.19, 1.74], P =0.0002), progression-free
survival (PFS) (HR =0.67 [95% CI 0.59, 0.77], P <0.00001),
and OS (HR =0.81 [95% CI 0.70, 0.95], P =0.008) in lung
cancer. In subgroup analyses, combination ICI therapy significantly prolonged
OS in non-small-cell lung cancer (NSCLC) patients (HR =0.80 [95% CI 0.73,
0.88], P <0.00001) but not in SCLC (HR
=0.94 [95% CI 0.82, 1.08], P =0.40) patients.
Data suggested that PD-1 inhibitors had higher efficacy and safety profiles
than PD-L1 and CTLA-4 inhibitors in combination ICI therapy for lung cancer
patients. Furthermore, tolerability analysis revealed higher incidences of
grade ≥3 AEs, fatigue, and increased transaminases from combination ICI
therapy. In conclusion, our meta-analysis indicated that combination ICI
therapy should be considered in clinical practice and future study designs for
NSCLC patients. However, the current data do not support the large-scale
clinical application of combination ICI therapy in SCLC patients.
Keywords: immune checkpoint inhibitor, lung cancer, combination therapy,
chemoradiotherapy, meta-analysis