Clinical Efficacy and Safety Analysis of PD-1/PD-L1 Inhibitor vs. Chemotherapy in the Treatment of Advanced Non-Small-Cell Lung Cancer: A Systematic Review and Meta-Analysis

Abstract

Objective. To systematically evaluate the efficacy and safety of pembrolizumab (PD-1/PD-L inhibitor) and adjuvant chemotherapy to treat NSCLC and provide evidence-based reference for clinical use. Methods. By searching the Cochrane Library, EMBASE, PubMed, and Web of Science, according to the inclusion criteria, literature selection, data extraction, and quality evaluation were carried out for the included literature. The I2 test was used to evaluate heterogeneity between studies, and the meta-analysis was performed using RevMan 5.3 software provided by Cochrane. Results. Finally, 14 relevant documents meeting the standards were included. It is a statistical difference in one-year survival rate [ $\text{OR}=1.50$ , 95% CI (1.28, 1.76), $P<0.00001$ , $I^2=0$ %, $Z=4.99$ ]; overall response rate[OR =1.57, 95% CI (1.29, 1.90), $P<0.00001$ , $I^2=0$ %, $Z=4.58$ ]; progression-free survival [ $\text{OR}=2.99$ , 95% CI (2.29, 3.91), $P<0.00001$ , $I^2=26$ %, $Z=8.00$ ]; and overall survival [ $\text{OR}=1.38$ , 95% CI (1.07, 1.78), $P=0.01$ , $I^2=46$ %, $Z=2.50$ ] and reduces the incidence of adverse drug reactions [ $\text{OR}=2.54$ , 95% CI (1.99, 3.25), $P<0.00001$ , $I^2=69$ %, $Z=7.43$ ]. Conclusion. Pembrolizumab adjuvant chemotherapy is effective in the treatment of advanced NSCLC, but attention should be paid to the occurrence of adverse reactions in clinical. Due to the limitations of the methodology included in the study, this conclusion required more validation of large-sample RCT.