Arriola Aperribay, EdurneGonzález Cao, MaríaDomine, ManuelDe Castro, JavierCobo, ManuelBernabé, ReyesNavarro, AlejandroSullivan, IvanaTrigo, José ManuelMosquera, JoaquínCrama, LeonardoIsla, Dolores2022-10-142022-10-142022Arriola E, González-Cao M, Domine M, De Castro J, Cobo M, Bernabé R, Navarro A, Sullivan I, Trigo JM, Mosquera J, Crama L, Isla D. Addition of immune checkpoint inhibitors to chemotherapy vs chemotherapy alone as first-line treatment in extensive-stage small-cell lung carcinoma: a systematic review and meta-analysis. Oncol Ther. 2022 Jun;10(1):167-84. DOI: 10.1007/s40487-021-00182-02366-1070http://hdl.handle.net/10230/54396Introduction: The addition of immune checkpoint inhibitors (ICIs) to conventional chemotherapy (CT) as first-line treatment improves survival in extensive-stage small-cell lung cancer (ES-SCLC). The aim of this meta-analysis was to determine the relative efficacy of first-line ICIs compared with CT in patients with ES-SCLC. Methods: Two independent reviewers extracted relevant data according to PRISMA guidelines and assessed the risk of bias using the Cochrane Collaboration's risk-of-bias tool. Meta-analysis was conducted using random-effects models to calculate an average effect size for overall survival (OS), progression-free survival (PFS), and safety outcomes in the overall populations and clinically relevant subgroups. Results: A literature search of PubMed and Embase was performed. Six randomized controlled clinical trials (IMpower133, CHECKMATE-451, CASPIAN, KEYNOTE-604, and phase II and III ipilimumab plus CT trials) with a total of 3757 patients were included. Compared with CT alone, ICIs plus CT showed a favourable effect on OS (hazard ratio [HR] 0.85; 95% confidence intervals [CI] 0.79-0.96) and PFS (HR 0.78; 95% CI 0.72-0.83) but a non-significant increase in the risk of experiencing any adverse event (relative risk, 1.05; 95% CI 0.99-1.11). The estimated HR for OS favoured ICI combinations in all planned subgroups according to age (< 65 years/≥ 65 years), sex (men/women), and ECOG performance status (0/1). Analysis by specific ICI revealed significant improvements in OS only for atezolizumab + CT (HR 1.36; 95% CI 1.09-1.69) and durvalumab + CT (HR 1.35; 95% CI 1.12-1.62) compared with CT alone. Conclusion: Combining anti-programmed cell death ligand 1 antibodies with platinum/etoposide is a superior therapeutic approach compared to CT alone for the first-line treatment of patients with ES-SCLC.application/pdfeng© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.info:eu-repo/semantics/articlehttp://dx.doi.org/10.1007/s40487-021-00182-0Anti-PD-1/PD-L1 antibodiesChemotherapyImmunotherapyMeta-analysisSmall cell lung carcinomainfo:eu-repo/semantics/openAccess