Abstract
Background: A direct comparison of programmed cell death-(ligand)1 (PD-(L)1) in combination with solvent-based paclitaxel (sb-paclitaxel) or albumin-bound paclitaxel (nab-paclitaxel) in advanced squamous non-small cell lung cancer (NSCLC) is currently lacking. Therefore, we conducted this network meta-analysis (NMA) to compare these two combination regimens.
Methods: We systematically searched articles from PubMed, Embase, Cochrane Library, and Web of Science, as well as abstracts from ESMO, ASCO, and WCLC, to identify phase III randomized controlled trials (RCTs) investigating first-line applications of PD-(L)1 inhibitors combined with sb-paclitaxel or nab-paclitaxel in the treatment of advanced squamous NSCLC.
Results: The present study consisted of 10 RCTs involving a total of 4352 patients. We compared ICIs+sb-paclitaxel to ICIs+nab-paclitaxel, PD-1+chemotherapy (chem) to PD-L1+chem, and different ICIs combination chemotherapy regimens. Our results revealed that compared to ICIs+nab-paclitaxel, ICIs+sb-paclitaxel exhibited a slightly better OS (hazard ratio (HR): 0.79, 95%CI: 0.58-1.08) and PFS (HR: 0.84, 95%CI: 0.65-1.07), although the differences were not statistically significant. In contrast to PD-L1+chem, PD-1+chem markedly prolonged OS (HR: 0.75, 95%CI: 0.60-0.93) and PFS (HR: 0.79, 95%CI: 0.66-0.96). In terms of the safety profile, there were no differences in the incidence of grade ≥3 TRAEs between ICIs+nab-paclitaxel and ICIs+sb-paclitaxel (RR: 1.05, 95%CI: 0.53-1.99), PD-1+chem and PD-L1+chem (RR: 0.93, 95% CI :0.68-1.28) as well as comparisons among various ICIs+chem regimens.
Conclusion: The efficacy and safety of ICIs+sb-paclitaxel is comparable to that of ICIs+nab-paclitaxel in advanced squamous NSCLC. However, ICIs+sb-paclitaxel exhibits a slightly improved PFS, OS, and similar safety profile, making it a potential preferred choice for first-line treatment.