Nivolumab provides improved effectiveness and safety compared with docetaxel as a second‐line treatment for advanced non‐small cell lung cancer: A systematic review and meta‐analysis

This is the first meta‐analysis to compare nivolumab and docetaxel‐based chemotherapy in advanced non‐small cell lung cancer (NSCLC) patients. Nivolumab was overall better than docetaxel‐based chemotherapy for advanced NSCLC in both anti‐tumor efficacy and safety. Based on our analysis of related literatures, NCCN guidelines for lung cancer and combined with our results, we suggest that 10% might be a suitable cutoff value of PD‐L1 expression for nivolumab treatment in NSCLC patients.

Abstract

Background

As an inhibitor of programmed death‐1 (PD‐1) protein, nivolumab has been shown to be effective in various cancers. We thus conducted this meta‐analysis to compare the relative efficacy of nivolumab vs docetaxel‐based chemotherapy as a second‐line treatment for previously treated advanced non‐small cell lung cancer (NSCLC).

Methods

Relevant studies were identified through searches of databases and conference proceedings. Progression‐free survival (PFS), overall survival (OS), drug responses, and adverse effects (AEs) were assessed as the primary endpoints.

Results

After screening, we included six studies (949 patients) in the final analysis. Nivolumab showed better efficacy in terms of the PFS (hazard ratios [HR]: 0.70, P = 0.03), OS (HR: 0.70, P < 0.00001), objective response rate (ORR) (risk ratios [RR]: 1.73, P = 0.0008), total AEs (RR: 0.77, P = 0.006), and grade 3‐5 AEs (RR: 0.18, P < 0.00001) than docetaxel. The anti‐tumor efficacy of nivolumab for NSCLC in terms of both PFS and OS was positively correlated with the level of PD‐L1 expression. In the nivolumab treatment arm, the 10 most‐reported AEs were fatigue (15.7%), nausea (10.8%), decreased appetite (10.3%), asthenia (9.8%), diarrhea (7.5%), rash (7.5%), arthralgia (5.4%), vomiting (4.4%), constipation (3.5%), and pyrexia (3.3%).

Conclusions

For advanced NSCLC, nivolumab is a better therapy in terms of both anti‐tumor efficacy and safety than docetaxel‐based chemotherapy. More high‐quality randomized controlled trials are needed to confirm these results.

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