Abdulaali R Almutairi1, Nimer Alkhatib2, Jennifer Martin3, Hani M Babiker4, Linda L Garland5, Ali McBride6, Ivo Abraham7. 1. Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA; Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy, University of Arizona, Tucson, AZ, USA. Electronic address: almutairi@pharmacy.arizona.edu. 2. Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA; Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy, University of Arizona, Tucson, AZ, USA. Electronic address: alsaid@pharmacy.arizona.edu. 3. Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA; Arizona Health Sciences Library, University Libraries, University of Arizona, Tucson, AZ, USA. Electronic address: martin@pharmacy.arizona.edu. 4. Division of Hematology and Oncology, College of Medicine, University of Arizona, Tucson, AZ, USA; University of Arizona Cancer Center, Tucson, AZ, USA. Electronic address: hanibabiker@email.arizona.edu. 5. Division of Hematology and Oncology, College of Medicine, University of Arizona, Tucson, AZ, USA; University of Arizona Cancer Center, Tucson, AZ, USA. Electronic address: lgarland@uacc.arizona.edu. 6. Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA; University of Arizona Cancer Center, Tucson, AZ, USA. Electronic address: mcbride@pharmacy.arizona.edu. 7. Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA; Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy, University of Arizona, Tucson, AZ, USA; University of Arizona Cancer Center, Tucson, AZ, USA; Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: abraham@pharmacy.arizona.edu.
Abstract
BACKGROUND: Two PD-1 (pembrolizumab, nivolumab) and one PD-L1(atezolizumab) inhibitors are approved for previously treated advanced non-small cell lung cancer but have not been compared in head-to-head trials. METHOD: A network meta-analysis was conducted to compare efficacy/safety of PD-1/PD-L1 inhibitors. RESULTS: In five-trials (including long-term updates) with docetaxel as common comparator there were no differences in OS and PFS between PD-1/PD-L1 inhibitors. Pembrolizumab (odds ratio(OR) = 2.22, 95%CrI = 1.28-3.70) and nivolumab (OR = 1.92, 95%CrI = 1.15-3.23) had higher ORRs than atezolizumab and at PD-L1 expression ≥50% and ≥1%. Probabilistically, pembrolizumab ranked first in OS and ORR, and in OS sub-analyses for adenocarcinoma, EGFR-mutant, ECOG-score-1, male, and age <65 years. Nivolumab ranked first in PFS, and in OS sub-analyses for squamous-cell disease, EGFR-wild-type, and ECOG-score-0. Pembrolizumab and nivolumab ranked the best option for most of adverse events. CONCLUSION: While pembrolizumab and nivolumab prevailed in rank in OS and ORR benefit, patient characteristics, safety and tolerance should be considered in treatment decision-making.
BACKGROUND: Two PD-1 (pembrolizumab, nivolumab) and one PD-L1(atezolizumab) inhibitors are approved for previously treated advanced non-small cell lung cancer but have not been compared in head-to-head trials. METHOD: A network meta-analysis was conducted to compare efficacy/safety of PD-1/PD-L1 inhibitors. RESULTS: In five-trials (including long-term updates) with docetaxel as common comparator there were no differences in OS and PFS between PD-1/PD-L1 inhibitors. Pembrolizumab (odds ratio(OR) = 2.22, 95%CrI = 1.28-3.70) and nivolumab (OR = 1.92, 95%CrI = 1.15-3.23) had higher ORRs than atezolizumab and at PD-L1 expression ≥50% and ≥1%. Probabilistically, pembrolizumab ranked first in OS and ORR, and in OS sub-analyses for adenocarcinoma, EGFR-mutant, ECOG-score-1, male, and age <65 years. Nivolumab ranked first in PFS, and in OS sub-analyses for squamous-cell disease, EGFR-wild-type, and ECOG-score-0. Pembrolizumab and nivolumab ranked the best option for most of adverse events. CONCLUSION: While pembrolizumab and nivolumab prevailed in rank in OS and ORR benefit, patient characteristics, safety and tolerance should be considered in treatment decision-making.
Authors: Laith Al-Showbaki; Michelle B Nadler; Alexandra Desnoyers; Fahad A Almugbel; David W Cescon; Eitan Amir Journal: J Cancer Date: 2021-05-19 Impact factor: 4.207