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First-line treatment options for PD-L1-negative non-small cell lung cancer: a Bayesian network meta-analysis

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Title: First-line treatment options for PD-L1-negative non-small cell lung cancer: a Bayesian network meta-analysis
Authors: Peng, L
Liang, W-H
Mu, D-G
Xu, S
Hong, S-D
Stebbing, J
Liang, F
Xia, Y
Item Type: Journal Article
Abstract: Background: First-line treatment strategies for programmed death-ligand 1 (PD-L1) negative non-small cell lung cancer (NSCLC) patients include chemotherapy and combination with anti-angiogenesis drugs and/or immune checkpoint inhibitor. We conducted a Bayesian network meta-analysis to evaluate the efficacy of these therapeutic options. Methods: We included phase III randomized controlled trials comparing two or more treatments in the first-line setting for NSCLC, including data in PD-L1-negative patients. First-line strategies were compared and ranked based on the effectiveness in terms of overall survival (OS) and progression-free survival (PFS). A rank was assigned to each treatment after Markov Chain Monte Carlo analyses. Results: Fourteen trials involving 14 regimens matched our eligibility criteria. For OS, none of the treatment were significantly more effective than chemotherapy. Nivolumab plus ipilimumab plus chemotherapy was probably the best option based on analysis of the treatment ranking (probability = 30.1%). For PFS, nivolumab plus chemotherapy plus bevacizumab, atezolizumab plus chemotherapy plus bevacizumab, and atezolizumab plus chemotherapy were statistically superior to chemotherapy in pairwise comparison. Nivolumab plus chemotherapy plus bevacizumab was likely to be the preferred option based on the analysis of the treatment ranking (probability = 72.9%). Conclusions: Nivolumab plus chemotherapy, in combination with angiogenesis inhibition or anti-cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), had maximal benefits for NSCLC patient of PD-L1-negative expression. These findings may facilitate individualized treatment strategies. Safety at an individual patient level should be considered in decision making. Further validation is warranted.
Issue Date: 23-Jun-2021
Date of Acceptance: 4-Jun-2021
URI: http://hdl.handle.net/10044/1/90383
DOI: 10.3389/fonc.2021.657545
ISSN: 2234-943X
Journal / Book Title: Front Oncol
Volume: 11
Copyright Statement: © 2021 Peng, Liang, Mu, Xu, Hong, Stebbing, Liang and Xia. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Sponsor/Funder: National Institute for Health Research
Imperial College Healthcare NHS Trust- BRC Funding
Funder's Grant Number: NIHR-RP-011-053
RDB01 79560
Keywords: immune checkpoint inhibitor
immunotherapy
network meta-analysis
non-small cell lung cancer
programmed death-ligand 1
immune checkpoint inhibitor
immunotherapy
network meta-analysis
non-small cell lung cancer
programmed death-ligand 1
1112 Oncology and Carcinogenesis
Publication Status: Published
Conference Place: Switzerland
Article Number: ARTN 657545
Appears in Collections:Department of Surgery and Cancer
Faculty of Medicine



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