This study is a meta-analysis of randomized controlled trials involving first-line studies in which immune checkpoint inhibitors were added to chemotherapy and were compared with chemotherapy alone. The primary end point was overall survival (OS). The analyses used random-effects models and the Grading of Recommendations Assessment, Development, and Evaluation system to rate the quality of the evidence. Nine articles were included for qualitative and quantitative synthesis. A meta-analysis of the nine randomized trials showed a significant benefit in terms of OS (hazard ratio: 0.75 [95% CI: 0.66-0.85]; p < 0.01). Only programmed death ligand-1 positive-high cancers derive a significant OS benefit. In this meta-analysis, there is moderate evidence that the addition of immune checkpoint inhibitors to chemotherapy may improve both OS compared with chemotherapy alone.
Keywords: PD-1; PD-L1; chemotherapy; combinations; first-line; immune checkpoint inhibitors; meta-analysis; non-small-cell lung cancer; randomized trials; survival.
Lay abstract We provide a meta-analysis of randomized controlled trials in first-line studies where immune checkpoint inhibitors were added to chemotherapy (CT) and were compared with CT alone. Nine articles were included for qualitative and quantitative synthesis. A meta-analysis of the nine randomized trials indicated a significant benefit in terms of overall survival (OS; hazard ratio: 0.75 [95% CI: 0.66–0.85]; p < 0.01). Only programmed death ligand-1 positive-high cancers were observed to receive a significant OS benefit. In this meta-analysis, there is moderate evidence that the addition of immune checkpoint inhibitors to CT may improve OS as compared with CT alone.