According to findings from a systematic review and meta-analysis presented at the 2024 National Comprehensive Cancer Network Annual Conference and also published in the National Comprehensive Cancer Network, researchers revealed that among patients with metastatic non–small cell lung cancer (NSCLC), the risk of developing pneumonitis was greater in patients who received PD-1 inhibitors than in those who received programmed death-ligand 1 (PD-L1) inhibitors.
The authors wrote, “Non–small cell lung cancer (NSCLC) is the most common type of lung cancer, often diagnosed at the advanced stage (metastatic). Treatment options for metastatic NSCLC include radiotherapy, chemotherapy, target drug therapy, and immunotherapy. Immunotherapy boosts the immune system to recognize and destroy cancer cells. However, it is often associated with immune-related complications such as pneumonitis.”
The study’s primary objective was to ascertain the incidence of pneumonitis among patients with metastatic NSCLC who were treated with various immunotherapy drugs.
The researchers scanned and gathered data for randomized, controlled trials (RCTs) from PubMed, Cochrane Library, and Google Scholar databases until October 2023. The authors noted that published RCTs with comparable research objectives were incorporated, while non-English articles, reviews, case reports, ongoing trials, nonrandomized studies, conference abstracts, and studies on small cell lung cancer (SCLC) were omitted. The researchers employed statistical analyses using the Comprehensive Meta-Analysis software.
The meta-analysis included 16 RCTs, which revealed that metastatic NSCLC patients treated with PD-1 inhibitors had higher incidences of any grade pneumonitis than PD-L1 inhibitor–treated patients, with rates of pneumonitis reported as 4.5% (nivolumab) and 5.1% (pembrolizumab) versus 1.6% (atezolizumab) and noted as statistically significant for those in the PD-L1 inhibitors as (P <.05).
The incidence of grade 3 or higher pneumonitis was also higher in patients who received PD-1 inhibitors than in those who received PD-L1 inhibitors.
In a subgroup analysis, the researchers discovered a higher rate of pneumonitis in treatment-naive patients (6.5%) than in previously treated patients (3.9%; P <.05). The rate of grade 3 or higher pneumonitis was also higher in treatment-naive patients (3.1%) than in previously treated patients (1.3%; P <.05).
Based on their findings, the authors concluded that PD-1 inhibitors have greater incidences of pneumonitis than PD-L1 inhibitors and reported that the frequencies of pneumonitis among patients on immunotherapy were more significant for patients with naive-treated metastatic NSCLC.
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