Comparative efficacy of chemoimmunotherapy versus immunotherapy for advanced non–small cell lung cancer: A network meta-analysis of randomized trials

Ranjan Pathak, Gilberto De Lima Lopes, Han Yu, Madan Raj Aryal, Wenyan Ji, Katherine Stemmer Frumento, Christopher J.D. Wallis, Zachary Klaassen, Henry S. Park, Sarah B. Goldberg

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Background: To the authors' knowledge, in the absence of head-to-head trials, it is unclear whether chemoimmunotherapy provides an additional overall survival (OS) benefit compared with immunotherapy alone in the first-line treatment of patients with advanced non–small cell lung cancer (NSCLC). The authors conducted a systematic literature review and network meta-analysis (NMA) to compare the efficacy of chemoimmunotherapy versus ICI. Methods: MEDLINE, Excerpta Medica dataBASE (EMBASE), Cochrane Central Register of Controlled Trials, and were searched from inception to April 2020. Phase 3 trials evaluating the efficacy of first-line ICI or chemoimmunotherapy and reporting efficacy outcomes (OS, progression-free survival [PFS], and the overall response rate [ORR]) stratified by programmed death–ligand 1 (PD-L1) status were included. NMA with a Bayesian random effects model was performed. Results: A total of 12 eligible trials comprising 7845 patients were included. In patients who were negative for PD-L1 (tumor proportion score [TPS] <1%), NMA comparing chemoimmunotherapy with dual-agent ICI failed to demonstrate a statistically significant difference with regard to OS, PFS, or the ORR. In patients with low PD-L1 (TPS 1%-49%), there was no statistically significant difference observed between chemoimmunotherapy compared with either single-agent ICI or dual-agent ICI with regard to OS or the ORR. In patients with high PD-L1 (TPS ≥50%), chemoimmunotherapy was found to be associated with an improved PFS and ORR compared with single-agent ICI, but not with dual-agent ICI. No differences in OS were observed with chemoimmunotherapy when compared with either single-agent or dual-agent ICIs. Conclusions: Although chemoimmunotherapy appears to improve the ORR and PFS in patients with PD-L1–high tumors when compared with single-agent ICI, it does not appear to confer an OS benefit over single-agent or dual-agent ICI for patients with advanced NSCLC regardless of PD-L1 status. Prospective trials are needed to validate these findings.

Original languageEnglish (US)
Pages (from-to)709-719
Number of pages11
Issue number5
StatePublished - Mar 1 2021


  • combination
  • drug therapy
  • immunotherapy
  • meta-analysis
  • network
  • non–small cell lung carcinoma
  • programmed cell death protein 1 receptor/antagonists and inhibitors
  • survival analysis
  • systematic review

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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