Publication-only abstracts (abstract number preceded by an "e"), published in conjunction with the 2019 ASCO Annual Meeting but not presented at the Meeting, can be found online only.
PD-1 versus PD-L1 inhibitors for previously treated advanced non-small cell lung cancer (NSCLC): Bayesian network meta-analysis (NMA).
Metastatic Non-Small Cell Lung Cancer
Lung Cancer—Non-Small Cell Metastatic
2019 ASCO Annual Meeting
J Clin Oncol 37, 2019 (suppl; abstr e20511)
Author(s): Abdulaali Almutairi, Ali McBride, Linda L. Garland, Ivo Abraham; University of Arizona College of Pharmacy, Tucson, AZ; University of Arizona Cancer Center, Tucson, AZ
Background: PD-1 (pembrolizumab, nivolumab; PD-1i) and PD-L1(atezolizumab, avelumab; PD-L1i) inhibitors have been evaluated in patients with advanced NSCLC who failed first line therapy. We performed a Bayesian NMA to compare PD-1i and PD-L1i as groups as to efficacy and safety. Methods: Medline and Embase were searched for phase 2/3 randomized controlled trials (RCT) of PD-1i/PD-L1i in pretreated NSCLC setting. Bayesian NMA with fixed effect model was used to compare efficacy (overall survival (OS), progression-free survival (PFS), objective response rate (ORR)) and safety (grade 3-5 adverse events (AE), pneumonitis, and discontinuation rate due to AEs ). Outcomes were expressed as hazard (HR) or odds ratio (OR) with 95% credible interval (Crl). Results: 6 RCTs (3 PD-1i, 3 PD-L1i) involved comparison to docetaxel and were included. Table summarizes the results. PD-1i were ranked as the first therapy for the efficacy measures (OS (96.5%), PFS (98%), and ORR (99.92%)), and for the rate of grade3-5 AEs (60.17%). PD-L1 ranked first for the discontinuation rate due to AEs (56,51%) and docetaxel ranked first for pneumonitis (99.98%). Conclusions: PD-1i had better PFS/ORR benefits and similar OS benefit and safety profile compared to PD-L1i. Compared to docetaxel, PD-1i showed better PFS/ORR benefits and both PD-1i/PD-L1i had better OS benefit, lower grade 3-5 AEs and AE related discontinuation rate, and higher risk of pneumonitis.
|Outcome||PD-1i vs. Docetaxel||PD-L1i vs. Docetaxel||PD-1i vs. PD-L1i|
|OS||0.67 (0.60 - 0.75)*||0.78 (0.69 - 0.88)*||0.85 (0.72 - 1.01)|
|PFS||0.83 (0.75 - 0.91)*||0.96 (0.86 - 1.08)||0.86 (0.74 - 0.99)*|
|ORR||2.03 (1.54 - 2.70)*||1.10 (0.85 - 1.44)||1.84 (1.26 - 2.71)*|
|Grade 3-5 AEs||0.17 (0.14 - 0.22)*||0.18 (0.14 - 0.22)*||0.96 (0.70 -1.32)|
|Pneumonitis||6.93 (2.68 - 23.99)*||5.38 (1.99 - 18.96)*||1.29 (0.27 - 6.22)|
|Discontinuation rate due to AEs||0.36 (0.25 - 0.52)*||0.35 (0.26 - 0.46)*||1.04 (0.65 - 1.66)|
OS, PFS: HR (95%CrI); ORR, AEs, pneumonitis, discontinuation: OR (95%CrI).
* statistically significant, 95%CrI does not include 1