First-Line Chemoimmunotherapy Versus Chemotherapy in PD-L1-Negative Patients with Non-Small-Cell Lung Cancer

Background: In PD-L1-negative patients with advanced non-small-cell lung cancer (NSCLC), conclusive evidence in support of specific treatments remains lacking. Objectives: The efficacy of first-line chemoimmunotherapy versus chemotherapy alone was compared. Methods: Eligible randomized studies that included patients with advanced NSCLC irrespective of PD-L1 status who were treated with chemoimmunotherapy as the first line were identified. Kaplan-Meier curves were extracted and analyzed using restricted mean survival time (RMST). Patient-level data were reconstructed from progression-free survival (PFS) graphs. A Bayesian network meta-analysis (NETMA) was carried out. Results: In five trials selected, chemoimmunotherapy regimens, compared with chemotherapy alone, resulted in an improvement in PFS without statistical significance. In the NETMA, chemoimmunotherapy was found to slightly improve PFS. Conclusion: This analysis showed that the incremental benefit of chemoimmunotherapy versus chemotherapy is limited.