Related Factors Affecting The Efficacy Of PD-1/PD-L1 Inhibitors In Patients With Advanced Non-small Cell Lung Cancer:A Meta-analysis

Objective:Using the method of Meta analysis,to systematically evaluate the clinical and molecular characteristics of the response to PD-1/PD-L1 inhibitors in patients with advanced NSCLC,in order to provide a basis for clinical decision-making.Materials and methods:The computer retrieves databases such as PubMed,EMbase,Web of science,The Cochrane Library,and CNKI,etc.the retrieval time limit was from the establishment of the database to January 2019.RCTs comparing the efficacy of PD-1/PD-L1 inhibitor monotherapy with chemotherapy in the treatment of patients with advanced non-small cell lung cancer were included.According to age,gender,histology,PS,smoking status,PD-L1 expression level,EGFR and KRAS mutation status,they were divided into subgroups,and the data of PFS and / or OS of each subgroup were extracted.RevMan 5.3 statistical software was used to analyze the difference of efficacy between PD-1/PD-L1 inhibitors and chemotherapy in each subgroup.Result:Eight randomized controlled clinical trials were included,for a total of 4,846 patients.The results of Meta analysis showed:(1)At age <75 years(HR=0.83,95% CI 0.70-0.97,P=0.02),male(HR=0.73,95% CI 0.59-0.90,P=0.003),squamous cell NSCLC(HR=0.68,95)%CI 0.55-0.85,P=0.0007),smoking(HR=0.75,95% CI 0.61-0.92,P=0.006),high expression of PD-L1(HR=0.57,95% CI 0.46-0.72;P<0.00001)PD-1/PD-L1 inhibitors have significant clinical benefit in patients with negative EGFR mutations(HR=0.83,95% CI 0.73-0.95,P=0.007),significantly prolonging patients’ PFS.(2)In terms of OS,except for age ≥ 75 years(HR = 1.24,95% CI 0.61-2.49,P = 0.55),no smoking history(HR = 1.03,95% CI 0.72-1.47,P = 0.89),EGFR mutation positive(Patients with HR=1.12,95% CI 0.80-1.56,P=0.52)and KRAS mutation negative(HR=0.89,95% CI 0.68-1.17,P=0.41),Regardless of gender,histology,PS score and PD-L1 expression,patients with PD-1/PD-L1 inhibitors had clinical benefits compared with chemotherapy,and patients with high PD-L1 expression may have greater clinical benefits.Conclusion:Age,gender,histology,smoking status,PD-L1 expression status,EGFR and KRAS mutation status are the related factors that influence the efficacy of PD-1/PD-L1 immune checkpoint inhibitors in patients with advanced non-small cell lung cancer.Clinicians can combine the above seven factors to select patients with advanced NSCLC who may benefit from PD-1/PD-L1 inhibitors to guide clinical medication.