A Meta Analysis Of Effectiveness And Safety Of PD-1/PD-L1 Inhibitors In The Treatment Of Non-small Cell Lung Cancer

Objective:To conduct a systematic evaluation and Meta analysis of the efficacy and safety of PD-1/PD-L1 inhibitors in the treatment of non-small cell lung cancer.The aim of this study is to provide the evidence-based medical evidence of PD-1/PD-L1 inhibitors in the treatment of NSCLC,put forward the problems existing in the current research of PD-1/PD-L1 inhibitors,and provide reasonable suggestions for the design and direction of clinical research in the future.Methods:The systematic evaluation method provided by the Cochrane collaboration was adopted,and the Chinese and English data were retrieved according to the established inclusion and exclusion criteria and the appropriate retrieval strategies like " PD-1/PD-L1???”?“??????”?“???? "“??”?“?? "?" Non-small cell lung cancer"?" Anti-PD-1?Anti-PD-L1 "?" immunotherapy"?" randomised controlled study”.According to the characteristics of Chinese and English databases such as CNKI,CBM,WanFang Data,Embase,Pubmed,Web of Science,Cochrane Library,etc.appropriate retrieval strategies were adopted to search the databases.Two researchers screened the literature and proceed three rounds of screening and discussion were conducted to determine the final inclusion,extract general information such as the name,author and time of publication of the included literature,curative effect information such as overall survival rate,progression-free survival period,1-year survival rate,objective remission rate,and safety information such as the incidence of grade 3?5 adverse reactions.At the same time,the risk of bias assessment tool provided by the Cochrane collaboration was used to evaluate the quality of the included literature from the aspects of randomization,randomization concealment and blindness.The quality of the included literature was assessed by using the risk of bias assessment tool provided by the Cochrane collaboration.Revman 5.3 was used to analyze the included literature and evaluate the efficacy and safety of PD-1/PD-L1 inhibitors in the treatment of NSCLC from the aspects of overall survival rate,progression-free survival,1-year survival rate,objective remission rate and incidence of grade 3?5 adverse reactions.Results:1.Compared with chemotherapy,PD-1/PD-L1 inhibitors can improve the overall survival and 1-year survival rate of patients with advanced NSCLC,and prolong the progression-free survival of patients.However,PD-1/PD-L1 inhibitors have no obvious advantage over chemotherapy in improving the objective response rate.2.Compared with chemotherapy,PD-1/PD-L1 inhibitors can reduce the incidence of grade 3?5 adverse reactions in patients with advanced NSCLC,but the incidence of grade 3?5 adverse reactions in patients with PD-1/PD-L1 inhibitors combined with chemotherapy is similar to that of chemotherapy.Conclusion:1.Compared with chemotherapy,PD-1/PD-L1 inhibitors have reliable efficacy and fewer adverse reactions in patients with advanced NSCLC,but they still need to be verified by multicenter,large sample,high-quality randomized controlled trials.2.The rate of adverse reactions of PD-1/PD-L1 inhibitor is less than that of chemotherapy,but there is still the possibility of serious adverse reactions,which may affect the continued use of the drug.In the future,the combination of traditional Chinese medicine and PD-1/PD-L1 inhibitor should be further explored to enhance the efficacy and reduce side effects.3.At present,studies on PD-1/PD-L1 inhibitors generally focus on the efficacy indicators such as OS,PFS and ORR,but lack the evaluation of patients' quality of life and psychological state.Therefore,more attention should be paid to patients'psychological state and quality of life in the future and further studies should be carried out on this.4.No clinical trials have been published on domestically marketed PD-1/PD-L1 inhibitors,and studies on the efficacy and adverse reactions of Chinese are lacking.International multicenter ?/? clinical trials of PD-1/PD-L1 inhibitors was conducted only in Japan,Taiwan area,and study sample size is small,there is still lack of effect of PD-1/PD-L1 inhibitors on Asian studies.