Immune Checkpoint Inhibitors +/− Chemotherapy for Patients With NSCLC and Brain Metastases: A Systematic Review and Network Meta‐Analysis
ABSTRACT Background Multiple studies have demonstrated the intracranial efficacy of immune checkpoint inhibitors (ICI) +/− chemotherapy. The efficacy of chemoimmunotherapy compared to ICI alone in patients with metastatic NSCLC and brain metastases (BM) remains unknown. Methods A systematic review a...
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| Format: | Article |
| Language: | English |
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Wiley
2025-01-01
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| Series: | Thoracic Cancer |
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| Online Access: | https://doi.org/10.1111/1759-7714.15510 |
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| author | Lauren Julia Brown Nicholas Yeo Harriet Gee Benjamin Y. Kong Eric Hau Inês Pires daSilva Adnan Nagrial |
| author_facet | Lauren Julia Brown Nicholas Yeo Harriet Gee Benjamin Y. Kong Eric Hau Inês Pires daSilva Adnan Nagrial |
| author_sort | Lauren Julia Brown |
| collection | DOAJ |
| description | ABSTRACT Background Multiple studies have demonstrated the intracranial efficacy of immune checkpoint inhibitors (ICI) +/− chemotherapy. The efficacy of chemoimmunotherapy compared to ICI alone in patients with metastatic NSCLC and brain metastases (BM) remains unknown. Methods A systematic review and network meta‐analysis were performed to evaluate ICI efficacy and the influence of additional chemotherapy on survival outcomes in treatment‐naïve metastatic NSCLC with BM. Randomized phase II/III studies with at least one treatment arm with an ICI were eligible. Overall survival (OS) and progression‐free survival (PFS) in patients with and without BM were assessed. Results Ten studies were included, totaling 6560 patients, 770 with BM. Pairwise meta‐analysis revealed that patients with BM treated with ICI +/− chemotherapy had improved PFS (hazard ratio [HR] 0.49; 95% CI 0.40–0.60) and OS (HR 0.55; 95% CI 0.44–0.68) versus chemotherapy alone. Patients without BM treated with ICI +/− chemotherapy also had improved PFS and OS compared to chemotherapy alone. In the network meta‐analysis of patients with BM, chemoimmunotherapy demonstrated improved PFS compared to ICI alone (HR 0.64; 95% CI 0.43–0.96; p = 0.03). No significant difference was observed in OS. In the population of patients without BM, no significant differences in PFS or OS were observed between chemoimmunotherapy versus ICI alone. Conclusion This meta‐analysis confirms that ICIs with or without chemotherapy are superior to chemotherapy alone for the first‐line management of metastatic NSCLC with and without BM. This network meta‐analysis suggests combination chemoimmunotherapy offers PFS benefit over ICI monotherapy in BM patients, warranting direct comparisons in clinical trials. Trial Registration: PROSPERO: CRD42024501345 |
| format | Article |
| id | doaj-art-ca3f4c3700e440218fec97da30936a57 |
| institution | Kabale University |
| issn | 1759-7706 1759-7714 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Thoracic Cancer |
| spelling | doaj-art-ca3f4c3700e440218fec97da30936a572025-01-30T22:40:34ZengWileyThoracic Cancer1759-77061759-77142025-01-01162n/an/a10.1111/1759-7714.15510Immune Checkpoint Inhibitors +/− Chemotherapy for Patients With NSCLC and Brain Metastases: A Systematic Review and Network Meta‐AnalysisLauren Julia Brown0Nicholas Yeo1Harriet Gee2Benjamin Y. Kong3Eric Hau4Inês Pires daSilva5Adnan Nagrial6Faculty of Medicine and Health University of Sydney Camperdown New South Wales AustraliaDepartment of Medical Oncology Prince of Wales Hospital Randwick New South Wales AustraliaFaculty of Medicine and Health University of Sydney Camperdown New South Wales AustraliaFaculty of Medicine and Health University of Sydney Camperdown New South Wales AustraliaFaculty of Medicine and Health University of Sydney Camperdown New South Wales AustraliaFaculty of Medicine and Health University of Sydney Camperdown New South Wales AustraliaFaculty of Medicine and Health University of Sydney Camperdown New South Wales AustraliaABSTRACT Background Multiple studies have demonstrated the intracranial efficacy of immune checkpoint inhibitors (ICI) +/− chemotherapy. The efficacy of chemoimmunotherapy compared to ICI alone in patients with metastatic NSCLC and brain metastases (BM) remains unknown. Methods A systematic review and network meta‐analysis were performed to evaluate ICI efficacy and the influence of additional chemotherapy on survival outcomes in treatment‐naïve metastatic NSCLC with BM. Randomized phase II/III studies with at least one treatment arm with an ICI were eligible. Overall survival (OS) and progression‐free survival (PFS) in patients with and without BM were assessed. Results Ten studies were included, totaling 6560 patients, 770 with BM. Pairwise meta‐analysis revealed that patients with BM treated with ICI +/− chemotherapy had improved PFS (hazard ratio [HR] 0.49; 95% CI 0.40–0.60) and OS (HR 0.55; 95% CI 0.44–0.68) versus chemotherapy alone. Patients without BM treated with ICI +/− chemotherapy also had improved PFS and OS compared to chemotherapy alone. In the network meta‐analysis of patients with BM, chemoimmunotherapy demonstrated improved PFS compared to ICI alone (HR 0.64; 95% CI 0.43–0.96; p = 0.03). No significant difference was observed in OS. In the population of patients without BM, no significant differences in PFS or OS were observed between chemoimmunotherapy versus ICI alone. Conclusion This meta‐analysis confirms that ICIs with or without chemotherapy are superior to chemotherapy alone for the first‐line management of metastatic NSCLC with and without BM. This network meta‐analysis suggests combination chemoimmunotherapy offers PFS benefit over ICI monotherapy in BM patients, warranting direct comparisons in clinical trials. Trial Registration: PROSPERO: CRD42024501345https://doi.org/10.1111/1759-7714.15510brain metastaseschemoimmunotherapyimmune checkpoint inhibitorsnetwork meta‐analysisnon‐small cell lung cancer |
| spellingShingle | Lauren Julia Brown Nicholas Yeo Harriet Gee Benjamin Y. Kong Eric Hau Inês Pires daSilva Adnan Nagrial Immune Checkpoint Inhibitors +/− Chemotherapy for Patients With NSCLC and Brain Metastases: A Systematic Review and Network Meta‐Analysis Thoracic Cancer brain metastases chemoimmunotherapy immune checkpoint inhibitors network meta‐analysis non‐small cell lung cancer |
| title | Immune Checkpoint Inhibitors +/− Chemotherapy for Patients With NSCLC and Brain Metastases: A Systematic Review and Network Meta‐Analysis |
| title_full | Immune Checkpoint Inhibitors +/− Chemotherapy for Patients With NSCLC and Brain Metastases: A Systematic Review and Network Meta‐Analysis |
| title_fullStr | Immune Checkpoint Inhibitors +/− Chemotherapy for Patients With NSCLC and Brain Metastases: A Systematic Review and Network Meta‐Analysis |
| title_full_unstemmed | Immune Checkpoint Inhibitors +/− Chemotherapy for Patients With NSCLC and Brain Metastases: A Systematic Review and Network Meta‐Analysis |
| title_short | Immune Checkpoint Inhibitors +/− Chemotherapy for Patients With NSCLC and Brain Metastases: A Systematic Review and Network Meta‐Analysis |
| title_sort | immune checkpoint inhibitors chemotherapy for patients with nsclc and brain metastases a systematic review and network meta analysis |
| topic | brain metastases chemoimmunotherapy immune checkpoint inhibitors network meta‐analysis non‐small cell lung cancer |
| url | https://doi.org/10.1111/1759-7714.15510 |
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