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Comparative efficacy and safety of licensed treatments for previously treated non-small cell lung cancer: A systematic review and network meta-analysis

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  • Xavier Armoiry
  • Alexander Tsertsvadze
  • Martin Connock
  • Pamela Royle
  • G J Melendez-Torres
  • Pierre-Jean Souquet
  • Aileen Clarke

Abstract

Purpose: This systematic review with network meta-analysis compared the efficacy and safety of currently licensed second-line treatments in patients with late stage non-small cell lung cancer (NSCLC). Methods: Randomised controlled trials (RCTs) of participants with advanced/metastatic NSCLC receiving second/third line treatments were screened. We searched electronic databases (MEDLINE; EMBASE; Web of Science) from January, 2000 to July, 2017. Findings: We included 11 RCTs (7,581 participants) comparing nine drugs. All drugs except for erlotinib significantly improved OS compared to docetaxel. Nivolumab was the highest ranking drug followed by atezolizumab and pembrolizumab. There was no significant difference in OS across these three drugs (HR = 0.98, 95% CI 0.79, 1.21 for nivolumab vs atezolizumab; HR = 0.98, 95% CI 0.77, 1.25 for nivolumab vs pembrolizumab). For PFS, ramucirumab + docetaxel and nivolumab were the drugs with the highest ranking. All interventions except ramucirumab + docetaxel had a reduced risk for severe drug-related AEs vs. docetaxel. Of the drugs with the highest ranking on AEs, nivolumab was significantly safer compared to atezolizumab (RR = 0.55, 95% CI 0.38, 0.79) or pembrolizumab (RR = 0.52, 95% CI 0.34, 0.81). Implications: Nivolumab, pembrolizumab and atezolizumab exhibited superior benefit/risk balance compared to other licensed drugs used late stage NSCLC. Our results indicate that the use of immunotherapies in people diagnosed with non-specific late stage NSCLC should be promoted. The use of docetaxel may now be judged irrelevant as a comparator intervention for approval of new drugs for second line treatment of NSCLC. Study registration number: PROSPERO CRD42017065928.

Suggested Citation

  • Xavier Armoiry & Alexander Tsertsvadze & Martin Connock & Pamela Royle & G J Melendez-Torres & Pierre-Jean Souquet & Aileen Clarke, 2018. "Comparative efficacy and safety of licensed treatments for previously treated non-small cell lung cancer: A systematic review and network meta-analysis," PLOS ONE, Public Library of Science, vol. 13(7), pages 1-18, July.
    • Handle: RePEc:plo:pone00:0199575
    DOI: 10.1371/journal.pone.0199575
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    References listed on IDEAS

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    1. Georgia Salanti & Cinzia Del Giovane & Anna Chaimani & Deborah M Caldwell & Julian P T Higgins, 2014. "Evaluating the Quality of Evidence from a Network Meta-Analysis," PLOS ONE, Public Library of Science, vol. 9(7), pages 1-14, July.
    2. Anna Chaimani & Julian P T Higgins & Dimitris Mavridis & Panagiota Spyridonos & Georgia Salanti, 2013. "Graphical Tools for Network Meta-Analysis in STATA," PLOS ONE, Public Library of Science, vol. 8(10), pages 1-12, October.
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