locally advanced PD-L1 positive Lung Cancer Non-Small Cell Cancer (NSCLC)

Locally Advanced PD-L1 Positive Lung Cancer Non-Small Cell Cancer (NSCLC)

Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, accounting for around 70-80% of all cases of lung cancer. NSCLC is heterogeneous and includes adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. Among these different histologies, locally advanced NSCLC accounts for a significant proportion of newly diagnosed cases, and is associated with dismal outcomes.

Immune checkpoint inhibitors (ICIs) are novel agents, approved by the FDA and recommended by the latest guidelines, that are used to treat patients with advanced NSCLC. The focus of most studies has been on the use of ICIs in metastatic, and more recently, locally advanced cases of NSCLC. PD-L1 expression in tumor cells and immune cells provides insight into the individual patient's likelihood of response to ICIs, and is considered an important predictive biomarker for the use of ICIs.

In order to better understand the efficacy of ICIs in patients with locally advanced PD-L1 positive NSCLC, researchers conducted a systematic review and meta-analysis of studies examining the effectiveness of ICIs in locally advanced PD-L1 positive NSCLC. A total of 16 studies (n=1836) were included in the systematic review and meta-analysis.

The results of the systematic review and meta-analysis showed that ICIs were associated with improved overall survival (OS) in patients with locally advanced PD-L1 positive NSCLC compared to chemotherapy. The median OS of patients who received ICIs was significantly longer than those who received chemotherapy (15.2 months vs 10.3 months, respectively). The results also showed that ICIs were associated with improved progression-free survival (PFS) and response rates (RR) compared to chemotherapy.

The results of this systematic review and meta-analysis demonstrate that ICIs are associated with improved OS, PFS, and response rates compared to chemotherapy in patients with PD-L1 positive locally advanced NSCLC. The results support the use of ICIs in the treatment of this unique population of patients who have limited options.

Adverse Events

Despite the clear benefit of ICIs, there is still an increased risk for adverse events (AEs). The most common AE reported in the studies included in the meta-analysis was pneumonitis (14.3%), followed by fatigue (9.2%), nausea (7.4%), and diarrhea (6.2%). The most common grade-3/4 AEs reported were pneumonitis (3.3%), fatigue (2.5%), and asthenia (1.5%). Unfortunately, there were also grade-4 AEs, including pneumonitis (1.2%) and fatigue (0.7%). Although the vast majority of AEs were reversible, AEs remain a concern in the use of ICIs.