Combination Of EP And Anti-PD-1 Pathway Or Anti-CTLA-4 For The Phase Ⅲ Trial Of Small Cell Lung Cancer:A Meta-analysis

The morbidity and mortality of lung cancer remain one of the highest among multiple cancers respectively.Small Cell Lung Cancer(SCLC),accounts for around 10%-15% of all lung cancers.Approximately,twothirds of the diagnosed SCLCs are in Extensive stage(ES).Decades later,we still rely on the same traditional regimen with etoposide and platinum(EP)as the mainstay of treatment with poor prognosis.This meta-analysis aims to assess the effect of adding Immune Checkpoints Inhibitors(CPIs)such as(ipilimumab,atezolizumab,pembrolizumab and,durvalumab)to the traditional EP regimen for small cell lung cancer-Extensive stage(EDSCLC).We searched through Pub Med looking for studies that compare between EP and CPIs,with EP,and only Phase III randomized controlled trials were considered eligible for this study.A total of 3645 papers were the results of the initial search,only 4 studies met our criteria.Each investigator extracted the data independently using the PRISMA MODEL(Preferred Reporting Items for Systematic Reviews and Meta-analyses)guideline.Each author used a prespecified sheet.The primary endpoint was to calculate OS(overall survival)and PFS(progression free survival)hazard ratios for both arms.We found that adding EP plus CPIs increased both OS(HR,95% CI 0.80[0.70,0.93],P=0.0001,I2=49%),and PFS(HR95% CI 0.81 [0.74,0.88],P<0.00001,I2=0%).On the other hand,ORR(overall response rate)was not affected by the addition of CPIs to EP compared to EP alone,and the same was true for adverse events.