Comparative efficacy of immune checkpoint inhibitors versus chemotherapy in advanced non-small cell lung cancer: a systematic review

Keywords

advanced non-small cell lung cancer - immune checkpoint inhibitors - chemotherapy

Introduction: Immune checkpoint inhibitors targeting the PD-1/PD-L1 axis have transformed first-line treatments for patients with advanced non-small cell lung cancer (NSCLC). PD-1 inhibitors are the standard of care for patients with PD-L1 expression ≥ 50% and also, alone or combined with chemotherapy when PD-L1 expression is < 50%. The PD-L1 inhibitor has also been approved for use in combination with chemotherapy and anti-angiogenic antibody in the first-line treatment of NSCLC despite PD-L1 expression. The combination of first-line PD-1/PD-L1 inhibitors with anti-CTLA-4 antibodies has also shown increased survival in patients with NSCLC.

Objectives: To compare the efficacy of immune checkpoint inhibitors (ICIs) and chemotherapy in patients with advanced non-small cell lung cancer. Overall survival, progression-free survival, and objective response rates, as well as safety profiles and adverse events associated with each treatment, were analyzed.

Methodology: Observational and retrospective study. Of the 97 articles identified, 12 were selected from the PubMed platform and a descriptive analysis of the collected data was performed.

Results: In the CheckMate 063 study, patients with advanced squamous cell lung cancer received Nivolumab, an immune checkpoint inhibitor. In 117 patients, the response rate was 14.5% and the disease stabilization rate was 26%. Two-year survival was observed in 27% of patients. A phase 3 study (CheckMate 017) compared Nivolumab with Docetaxel, a chemotherapeutic agent, with 272 patients randomized to receive Nivolumab 3mg/kg every 2 weeks or Docetaxel 75mg/m² every 3 weeks. The 1-year survival rate was 41% with Nivolumab and 24% with Docetaxel.

Conclusion: In patients with advanced NSCLC, the use of immune checkpoint inhibitors, such as the PD-1 inhibitor nivolumab, showed higher response rates, stabilization, and 2-year survival. When compared to chemotherapy treatment in a phase 3 study, ICIs demonstrated a 17% increase in 1-year survival rate compared to the chemotherapeutic agent Docetaxel. These findings highlight the choice of ICIs for the treatment of advanced non-small cell lung cancer, considering the high mortality rate of this disease.

Corresponding author: Marya Clara Araújo da Silva (e-mail: [e-mail]).