Rapid health technology assessment of PD-1/PD-L1 inhibitors for the treatment of patients with NSCLC_Chinese Journal of Evidence-Based Medicine

Authors：

GAO Xu , LU Chang , LI Ding , LIANG Yuwei , ZHENG Yuxuan , ZHANG Yuxian , AN Minghui ,  GONG Jian

Drug Epidemiology and Clinical Drug Evaluation Group, Shenyang Pharmaceutical University, Shenyang 110016, P. R. China;

Corresponding?author：

GONG Jian, Email: fanxing1230@163.com

Keywords：

PD-1; PD-L1; NSCLC; Health economic tudies; rHTA

DOI：

10.7507/1672-2531.202504148

Video：

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Objective To evaluate the efficacy, safety and economy of PD-1/PD-L1 inhibitors for non-small cell lung cancer (NSCLC), and to provide an evidence-based basis for clinical dosing and decision-making. Methods Computerized searches of PubMed, Embase, Cochrane Library, CNKI, WanFang Data, VIP and official websites of domestic and international health technology assessment (HTA) organizations were conducted to collect HTA reports, safety and economic data on the use of PD-1/PD-L1 inhibitors (nabulizumab, pembrolizumab, cimeplizumab, atilizumab, and duvarizumab) for NSCLC HTA reports, systematic reviews (SR)/Meta-analyses, and pharmacoeconomic studies, all with a search timeframe of March 2024 from the time of library construction. After data extraction and quality assessment, the results of the included studies were analyzed descriptively. Results A total of 16 papers were included, including 16 SR/Meta analyses and 2 pharmacoeconomic studies. Compared with first-line chemotherapy, PD-1/PD-L1 inhibitors increased the efficiency and disease control rate, prolonged the survival time, improved the quality of survival, and reduced grade 3-5 treatment-related adverse effects (including fatigue, dyspnea, anemia, pneumonia, severe skin reactions, nausea, diarrhea, decreased appetite, and leukopenia) in NSCLC patients. Cemiplizumab was cost-effective when the WTP threshold was $100 000/QALY, and pembrolizumab was cost-effective when the WTP threshold was $150 000/QALY. Conclusion PD-1/PD-L1 inhibitors (nabulizumab, pabolizumab, cimiplizumab, atilizumab, and duvarizumab) are efficacious, safe, and cost-effective for use in NSCLC; however, given the small number of pharmacoeconomic studies included, economic conclusions drawn need to be interpreted with caution.

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6.	張欣, 高潔, 張慧勤, 等. PD-1/PD-L1抑制劑與非小細胞肺癌的臨床研究進展. 醫學研究雜志, 2022, 51(12): 173-177.
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10.	晏莉. 化療聯合免疫檢查點抑制劑對比單純化療一線治療晚期非小細胞肺癌療效及安全性的Meta分析. 重慶: 重慶醫科大學, 2020.
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12.	李晨露, 陳燕, 王心怡. PD-L1抑制劑治療晚期非小細胞肺癌有效性與安全性的meta分析. 北京: 2016年中國藥學大會暨第十六屆中國藥師周論文集. 2016: 328-335.
13.	鐘紅. PD-1抑制劑聯合化療對比化療一線治療晚期NSCLC有效性及安全性的網狀Meta分析. 中國新藥與臨床雜志, 2023, 42(6): 356-362.
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15.	付鵬, 王超, 李翔, 等. PD-1/PD-L1抗體與多西紫杉醇治療晚期非小細胞肺癌的總體療效及安全性Meta分析. 腫瘤藥學, 2019, 9(1): 155-159.
16.	Herbst R, Jassem J, Abogunrin S, et al. A network meta-analysis of cancer immunotherapies versus chemotherapy for first-line treatment of patients with non-small cell lung cancer and high programmed death-ligand 1 expression. Front Oncol, 2021, 11: 676732.
17.	You W, Liu M, Miao JD, et al. A network meta-analysis comparing the efficacy and safety of anti-PD-1 with anti-PD-L1 in non-small cell lung cancer. J Cancer, 2018, 9(7): 1200-1206.
18.	Peng TR, Lin HH, Tsai FP, et al. Immune checkpoint inhibitors for first-line treatment of advanced non-small-cell lung cancer: a systematic review and network meta-analysis. Thorac Cancer, 2021, 12(21): 2873-2885.
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20.	Liu Q, Zhou Z, Luo X, et al. First-line ICI monotherapies for advanced non-small-cell lung cancer patients with PD-L1 of at least 50%: a cost-effectiveness analysis. Front Pharmacol, 2021, 12: 788569.
21.	Wang L, Yang Y, Yu J, et al. Efficacy and safety of anti-PD-1/PD-L1 in combination with chemotherapy or not as first-line treatment for advanced non-small cell lung cancer: a systematic review and network meta-analysis. Thorac Cancer, 2022, 13(3): 322-337.
22.	Wang DD, Shaver LG, Shi FY, et al. Comparative efficacy and safety of PD-1/PD-L1 immunotherapies for non-small cell lung cancer: a network meta-analysis. Eur Rev Med Pharmacol Sci, 2021, 25(7): 2866-2884.
23.	Jiang M, Liu C, Ding D, et al. Comparative efficacy and safety of anti-PD-1/PD-L1 for the treatment of non-small cell lung cancer: a network meta-analysis of 13 randomized controlled studies. Front Oncol, 2022, 12: 827050.
24.	Khan M, Lin J, Liao G, et al. Comparative analysis of immune checkpoint inhibitors and chemotherapy in the treatment of advanced non-small cell lung cancer: a meta-analysis of randomized controlled trials. Medicine (Baltimore), 2018, 97(33): e11936.
25.	Ramos-Esquivel A, van der Laat A, Rojas-Vigott R, et al. Anti-PD-1/anti-PD-L1 immunotherapy versus docetaxel for previously treated advanced non-small cell lung cancer: a systematic review and meta-analysis of randomised clinical trials. ESMO Open, 2017, 2(3): e000236.

1. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. 伍家鳴, 王菁, 林麗珠, 等. 艾迪注射液聯合一線化療方案治療非小細胞肺癌臨床療效的Meta分析. 中成藥, 2017, 39(6): 1323-1328.
3. 中華醫學會腫瘤學分會. 中華醫學會肺癌臨床診療指南(2024版). 中華醫學雜志, 2024, 104(34): 3175-3213.
4. 李慧, 王俊彥, 王萌萌, 等. 康萊特注射液聯合GP化療方案對中晚期非小細胞肺癌治療作用的Meta分析. 藥物流行病學雜志, 2022, 31(6): 363-370.
5. 許聰聰, 黃柳綠, 唐姣, 等. 艾迪注射液聯合一線化療用于NSCLC的快速衛生技術評估. 中國藥房, 2023, 34(10): 1247-1251.
6. 張欣, 高潔, 張慧勤, 等. PD-1/PD-L1抑制劑與非小細胞肺癌的臨床研究進展. 醫學研究雜志, 2022, 51(12): 173-177.
7. 宮建, 張靈健, 丁選勝, 等. 健康中國建設對臨床藥學專業學位研究生教學模式影響. 中國公共衛生, 2021, 37(11): 1718-1720.
8. 唐惠林, 門鵬, 翟所迪. 藥物快速衛生技術評估方法及應用. 臨床藥物治療雜志, 2016, 14(2): 1-4.
9. 李旭晗, 冼靜怡, 楊燕, 等. 藥物流行病學在臨床藥物評價中的應用. 醫藥導報, 2023, 42(9): 1368-1374.
10. 晏莉. 化療聯合免疫檢查點抑制劑對比單純化療一線治療晚期非小細胞肺癌療效及安全性的Meta分析. 重慶: 重慶醫科大學, 2020.
11. Li Y, Liang X, Yang T, et al. Pembrolizumab vs. cemiplimab for the treatment of advanced non-small cell lung cancer with PD-L1 expression levels of at least 50%: a network meta-analysis and cost-effectiveness analysis. Front Oncol, 2022, 12: 878054.
12. 李晨露, 陳燕, 王心怡. PD-L1抑制劑治療晚期非小細胞肺癌有效性與安全性的meta分析. 北京: 2016年中國藥學大會暨第十六屆中國藥師周論文集. 2016: 328-335.
13. 鐘紅. PD-1抑制劑聯合化療對比化療一線治療晚期NSCLC有效性及安全性的網狀Meta分析. 中國新藥與臨床雜志, 2023, 42(6): 356-362.
14. 劉貞. PD-1/PD-L1抑制劑與化療治療非小細胞肺癌療效及安全性的meta分析. 南京: 東南大學, 2018.
15. 付鵬, 王超, 李翔, 等. PD-1/PD-L1抗體與多西紫杉醇治療晚期非小細胞肺癌的總體療效及安全性Meta分析. 腫瘤藥學, 2019, 9(1): 155-159.
16. Herbst R, Jassem J, Abogunrin S, et al. A network meta-analysis of cancer immunotherapies versus chemotherapy for first-line treatment of patients with non-small cell lung cancer and high programmed death-ligand 1 expression. Front Oncol, 2021, 11: 676732.
17. You W, Liu M, Miao JD, et al. A network meta-analysis comparing the efficacy and safety of anti-PD-1 with anti-PD-L1 in non-small cell lung cancer. J Cancer, 2018, 9(7): 1200-1206.
18. Peng TR, Lin HH, Tsai FP, et al. Immune checkpoint inhibitors for first-line treatment of advanced non-small-cell lung cancer: a systematic review and network meta-analysis. Thorac Cancer, 2021, 12(21): 2873-2885.
19. Lu Y, Zhang X, Ning J, et al. Immune checkpoint inhibitors as first-line therapy for non-small cell lung cancer: a systematic evaluation and meta-analysis. Hum Vaccin Immunother. 2023, 19(1): 2169531.
20. Liu Q, Zhou Z, Luo X, et al. First-line ICI monotherapies for advanced non-small-cell lung cancer patients with PD-L1 of at least 50%: a cost-effectiveness analysis. Front Pharmacol, 2021, 12: 788569.
21. Wang L, Yang Y, Yu J, et al. Efficacy and safety of anti-PD-1/PD-L1 in combination with chemotherapy or not as first-line treatment for advanced non-small cell lung cancer: a systematic review and network meta-analysis. Thorac Cancer, 2022, 13(3): 322-337.
22. Wang DD, Shaver LG, Shi FY, et al. Comparative efficacy and safety of PD-1/PD-L1 immunotherapies for non-small cell lung cancer: a network meta-analysis. Eur Rev Med Pharmacol Sci, 2021, 25(7): 2866-2884.
23. Jiang M, Liu C, Ding D, et al. Comparative efficacy and safety of anti-PD-1/PD-L1 for the treatment of non-small cell lung cancer: a network meta-analysis of 13 randomized controlled studies. Front Oncol, 2022, 12: 827050.
24. Khan M, Lin J, Liao G, et al. Comparative analysis of immune checkpoint inhibitors and chemotherapy in the treatment of advanced non-small cell lung cancer: a meta-analysis of randomized controlled trials. Medicine (Baltimore), 2018, 97(33): e11936.
25. Ramos-Esquivel A, van der Laat A, Rojas-Vigott R, et al. Anti-PD-1/anti-PD-L1 immunotherapy versus docetaxel for previously treated advanced non-small cell lung cancer: a systematic review and meta-analysis of randomised clinical trials. ESMO Open, 2017, 2(3): e000236.

Chinese Journal of Evidence-Based Medicine

Latest ArticlesRapid health technology assessment of PD-1/PD-L1 inhibitors for the treatment of patients with NSCLC

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