Meta-analysis Of The Efficacy And Safety Of Chemotherapy Combined With Immune Checkpoint Inhibitors And Chemotherapy Alone In The First-line Treatment Of Advanced Non-small Cell Lung Cancer

Objective This study analysised the efficacy and safety of Immune-checkpoint inhibitors combined with Chemotherapy as First-line therapy in Advanced Non–Small Cell Lung cancer.Methods A systematic search in PubMed,Embase and the Cochrane Library was performed.Eligible studies included RCTs comparing ICIs(PD-1/PD-L1inhibitors?CTLA-4 inhibitors)combined with CT with CT in the treatment of Advanced NSCLC.After removing the duplicate literature,the studies were preliminarily screened by reading the title and abstract,the studies were screened again by reading the full text according to the inclusion criteria and exclusion criteria.Meanwhile the quality evaluation and data extraction of the original literature were conducted.Rev Man5.3software was used for data analysis.Results A total of 11 RCTs and 5980 patients were included in the meta-analysis.The Meta-analysis revealed a significant improvement in PFS(HR =0.64,95% CI 0.58–0.71;p < 0.00001))and OS(HR =0.77,95% CI0.69–0.86;p < 0.00001)with ICIs combined with CT in Advanced NSCLC.The incidence of AEs was similar to that of chemotherapy alone.However,the OR value of grade 3 and above AEs in the combination group VS the Chemotherapy group was 1.52(1.36-1.70,p < 0.0001).The data stratification showed that Pembrolizumab combined with CT was associated with a significant prolongation of PFS(HR =0.54,95% CI 0.47–0.62;p < 0.00001)and OS(HR =0.57,95% CI 0.48–0.69;p <0.00001).Meanwhile,AEs had no significant difference between the combination groupand the Chemotherapy group.Secondly,Subgroup analysis showed that chemotherapy combined with ICIs had a significant prolongation of PFS and OS in both NSQ-NSCLC and SQ-NSCLC,the difference was statistically significant.Conclusion The results of this study suggest that ICIs combined with Chemotherapy have a significant effect in Advanced NSCLC as first line therapy,the incidence of grade 3 and above AEs was higher than chemotherapy,but can be controlled and was in the acceptable range.