Long-term survivors with second-line immunotherapies for advanced non-small cell lung cancer

INTRODUCTION: Immune checkpoint inhibitors (ICIs) have replaced standard chemotherapy (e.g., docetaxel) as the second-line therapy for non-small cell lung cancer (NSCLC). Agents like nivolumab, pembrolizumab, and atezolizumab have shown significant improvements in overall survival (OS). This study aims to evaluate the long-term efficacy of these agents in NSCLC patients through an indirect network meta-analysis (NMA) using the most recent data available.EVIDENCE ACQUISITION: Our systematic search spanned PubMed, Embase, and the Cochrane Library, focusing on papers published up to December 2023 that reported data with a median follow-up of 48-60 months. We included randomized trials involving NSCLC patients receiving second-line or later therapy with an approved ICI.EVIDENCE SYNTHESIS: Four trials met our inclusion criteria. In the pairwise meta-analysis, nivolumab exhibited the highest relative risk (RR) in comparison to docetaxel (RR 7.26; 95% CI 2.61-20.18) and was predicted to outperform atezolizumab in the NMA (RR 5.53; 95% CI 1.73-17.75). The Surface Under The Cumulative Ranking (SUCRA) estimated a 65% probability that nivolumab is the preferred treatment for extending OS in PD-L1-positive NSCLC patients. For PD-L1-negative subgroups, nivolumab and atezolizumab demonstrated similar effectiveness.CONCLUSIONS: While all approved ICIs for second or subsequent lines of therapy contribute to long-term survival in NSCLC, nivolumab appears to be more effective in PD-L1-positive patients. In contrast, nivolumab and atezolizumab show comparable efficacy in PD-L1-negative cases. These findings underline the importance of personalized treatment strategies based on biomarker expression.