| Introduction Non-small cell lung cancer ranks first for morbidity and mortality of lung cancer.At present,immunotherapy is a hot spot in the treatment of non-small cell lung cancer and is an effective treatment for non-small cell lung cancer after surgery,radiotherapy,chemotherapy and targeted therapy.This article systematically evaluated the efficacy and safety of PD-1/ PD-L1 inhibitors in the treatment of non-small cell lung cancer.Methods To apply finding aids by computer or hand including PUBMED,EMBASE and Wanfang Date databases,and reviewing other unpublished doctoral or master’s subjects.The key words included “pembrolizumab/lambrolizumab/Keytruda/MK-3475/PEMBRO”,“MPDL-3280A”,“MEDI-4736”,“Nivolumab/ONO-4538/BMS-936,558/ MDX-1106/ Opdivo”,“AMP-224”,“BMS-936/MDX-1105”,“pidilizumab/CT-011” and “lung cancer/ carcinoma”.The relevant data were required from 2017-November.Two reviewers evaluated the quality of searched literature according to quality evaluation standards(Jadad),extracted data independently in accordance with inclusion and exclusion criteria,and settled differences and problems through negotiation.Unified date with Get Date Graph Digitizer,and analyzed data by meta analyses with the RevMan5.3 software provided by Cochrane Collaboration.Results1.PD-1/PD-L1 inhibitors was compared with chemotherapy for ORR,RR=1.69,95%CI[1.42,2.00],P<0.01;PD-1/PD-L1 inhibitors was compared with chemotherapy for OS,HR=0.67,95%CI [0.61,0.74],P<0.01;PD-1/PD-L1 inhibitors was compared with chemotherapy for PFS,HR=0.72,95%CI [0.60,0.86],P<0.01.PD-1/PD-L1 inhibitors in the treatment of non-small cell lung cancer was significantly better than chemotherapy,the difference was statistically significant.2.The different expression of PD-L1 on the efficacy of PD-1/ PD-L1 inhibitors was RR=2.87,95%CI [0.90,9.17],P<0.01.The ORR of PD-1/PD-L1 inhibitors in non-small cell lung cancer patients was affected by the expression of PD-L1 in non-small cell lung cancer patients.The efficacy of PD-1/PD-L1 inhibitors was significantly greater in patients with a higher PD-L1 expression(positive)than that is lower(negative).3.The ORR of the adverse events of immunotherapy compared to traditional chemotherapy was RR=0.84,95%CI [0.71,0.98],P<0.01.The occurrence rate of adverse events of chemotherapy was significantly higher than that of immunotherapy.For adverse events of grade 3 and above,the occurrence rate was RR=0.3,95% CI [0.19,0.46],P<0.01.Indicates that the occurrence rate of Grade 3 and above adverse events in chemotherapy are also higher than immunotherapy.Conclusions1.PD-1/ PD-L1 inhibitors are a kind of negative immunotherapy,designed to inhibit the immune escape mechanism of the tumor in the human body.Through a series of clinical trials of Phase II and III,we found there is an advantage that immunotherapy in the improvement of non-small cell lung cancer patients with ORR,OS and PFS.2.The effect of different expression of PD-L1 on PD-1/ PD-L1 inhibitors was also analyzed.The higher expression of PD-L1,the better efficacy of immunotherapy,the results suggest that the patient’s screening is particularly important to the use of immunotherapy.3.Immunotherapy is not perfect,there are many adverse events with PD-1/ PD-L1 inhibitors.However,compared with the chemotherapy,all kinds of adverse events or 3 and 3 or more adverse events,immunotherapy adverse events far less than chemotherapy. |
