Smokers or non-smokers: who benefits more from immune checkpoint inhibitors in treatment of malignancies? An up-to-date meta-analysis
Posted on 2020-01-21 - 05:11
Abstract Background Immune checkpoint inhibitors, which are a milestone in anti-cancer therapy, have been applied in the treatment of multiple malignancies. Real-world data have suggested that smoking status may be associated with the efficacy of anti-PD-1/PD-L1 therapy. Hereby, to evaluate “smoking benefit or not”, we included numerous high-quality randomized controlled clinical trials (RCTs) without any restriction on category. Methods A systematic search of online database was performed from July 2010 to July 2019. Eligible studies included phase II/III RCTs comparing PD-1/PD-L1 inhibitors with chemotherapy in the treatment of multiple carcinomas and contained subgroup analysis of smoking status. Then, related hazard ratios (HRs) with 95% confidence intervals (CIs) of overall survival (OS) were pooled. Results In the initial meta-analysis, compared with chemotherapy, the OS of non-smokers (HR, 0.81; 95% CI, 0.67–0.98) and smokers (HR, 0.77; 95% CI, 0.71–0.83) were significantly prolonged with PD-1/PD-L1 inhibitors. Outcomes from subgroup analysis showed that in anti-PD-1/PD-L1 monotherapy groups, non-smokers showed no significant improvement in OS (HR, 0.94; 95% CI, 0.83–1.06), while the OS of smokers was significantly prolonged (HR, 0.79; 95% CI, 0.74–0.85); in groups of PD-1/PD-L1 inhibitors combined with chemotherapy, the OS of non-smokers (HR, 0.45; 95% CI, 0.28–0.71) and smokers (HR, 0.72; 95% CI, 0.61–0.85) were significantly prolonged. Combined ipilimumab and chemotherapy showed no significance in both groups. Conclusion Smokers benefit from either anti-PD-1/PD-L1 monotherapy or the combined regimen compared with chemotherapy. Considering cost-effectiveness, monotherapy was recommended to smokers. For non-smokers, only the combined regimen was feasible in non-small cell lung cancer.
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Mo, Jiahang; Hu, Xiao; Gu, Lihu; Chen, Bangsheng; Khadaroo, Parikshit; Shen, Zefeng; et al. (2020). Smokers or non-smokers: who benefits more from immune checkpoint inhibitors in treatment of malignancies? An up-to-date meta-analysis. figshare. Collection. https://doi.org/10.6084/m9.figshare.c.4823841.v1
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AUTHORS (10)
JM
Jiahang Mo
XH
Xiao Hu
LG
Lihu Gu
BC
Bangsheng Chen
PK
Parikshit Khadaroo
ZS
Zefeng Shen
LD
Lei Dong
YL
Yuqi Lv
MC
Marylin Chitumba
JL
Jiequan Liu