This study aimed to evaluate the safety and efficacy of PD-1/PD-L1 ICI plus chemotherapy versus chemotherapy alone in ES-SCLC, following PRISMA guidelines.23 studies(10RCTs,13RWSs) with 6364 patients were enrolled,with OS,PFS,ORR and grade 3-4 AEs as primary endpoints. Pooled analyses demonstrated that ICI + chemotherapy (CT) significantly improved OS (HR = 0.68) and PFS (HR = 0.60), and ORR (RR = 1.13). Subgroup analyses confirmed consistent OS/PFS benefits in both RCT and RWS cohorts. Both PD-1 and PD-L1 inhibitors improved survival; PD-1 inhibitors yielded greater PFS benefit(HR=0.49) and significant ORR improvement, while PD-L1 inhibitors showed no significant ORR elevation. The combination slightly increased overall AEs with no difference in severe events, with manageable safety.This meta-analysis supports chemoimmunotherapy as first-line treatment for ES-SCLC.
Li et al. (Wed,) studied this question.