A Safety and Efficacy Meta-Analysis of Immune Checkpoint Inhibitors for Non-Small Cell Lung Cancer

Abstract

Specific Aims: The objective of this study was to compare the median progression-free survival and safety profiles of the immune checkpoint inhibitors nivolumab, pembrolizumab, and atezolizumab in patients with non-small cell lung cancer. Other analyses included the incidence of any grade adverse event, any grade nausea, fatigue, and diarrhea. Methods: This meta-analysis included the original Phase II and Phase III clinical trials that lead to the approval of these agents. A screening tool was used to identify studies to be included, and a data extraction tool was utilized for data collection. One-way ANOVA and Chi-square tests were used to analyze the results. Main Results: Median progression-free survival was not equal between the three drugs (p=0.0007). Pembrolizumab provided the longest median progression-free survival of 9.6 months compared to both atezolizumab (3.1 months, p=0.029), and nivolumab (3.3 months, p=0.041). Despite its efficacy, pembrolizumab had a higher incidence of adverse events leading to discontinuation than both atezolizumab and nivolumab (p<0.00001). While there was not a significant difference in the incidence of any grade adverse events between pembrolizumab and atezolizumab (p=0.24), nivolumab showed significantly less incidence than the other drugs (p<0.00001). Conclusions: The results of this study suggest that nivolumab, pembrolizumab, and atezolizumab are not equally effective or safe. While pembrolizumab provided the longest median progression-free survival, it also had the highest rates of discontinuation due to adverse effects. These differences in efficacy and side effect profiles can aid oncologists in choosing the most appropriate agent for their patients with non-small cell lung cancer.