Objective To evaluate the efficacy, safety, and economy of tislelizumab (TIS) as a first-line treatment for advanced non-small cell lung cancer (NSCLC).
Methods PubMed, Embase, Cochrane Library, CNKI, WanFang Data, SinoMed databases and health technology assessment (HTA) websites were electronically searched to collect the HTA report, systematic review/Meta-analysis and pharmacoeconomic research of TIS as a first-line treatment for advanced NSCLC from the inception to April 30, 2024. Two reviewers independently screened literature, extracted data, and evaluated quality, and qualitative descriptive methods were used for rapid health technology assessment (rHTA).
Results A total of 9 articles were included, in which 7 systematic review/Meta-analysis and 2 pharmacoeconomic studies. In terms of effectiveness, compared with chemotherapy (CT), TIS+CT could improve the progression free survival (PFS) and objective response rate (ORR) of advanced NSCLC patients. It could also improve PFS in patients with advanced NSCLC who have the any expression of programmed cell death receptor ligand-1 (PD-L1), with or without liver metastasis, aged ≥ 65 years or<65 years, and with a history of smoking; Compared with CT, TIS+CT could improve the PFS of advanced non squamous NSCLC patients, and could increase the PFS of advanced non squamous NSCLC patients with PD-L1 ≥ 50%; Compared with CT, TIS+CT could improve the PFS of patients with advanced squamous cell carcinoma NSCLC in stages IIIB and IV, with PD-L1 being 1%-49%, PD-L1 ≥ 50%, male, age ≥ 65 years old, smoking history, ECOG score of 1 point. In terms of safety, compared with camrelizumab+CT and atezolizumab+bevacizumab+CT, TIS+CT could reduce the incidence of serious adverse reactions. In terms of economics, for non squamous NSCLC without epidermal growth factor receptor (EGFR) mutations and gradual lymphoma kinase (ALK) rearrangements, TIS+CT had certain cost-effectiveness advantages compared to CT in China. The subgroup analysis results showed that the first-line TIS+CT regimen had greater survival benefits in non squamous NSCLC patients with PD-L1 expression ≥ 50%, liver metastasis, and a history of smoking.
Conclusion TIS+CT first-line treatment for advanced NSCLC has good efficacy, safety, and economy.
1.郑荣寿, 陈茹, 韩冰峰, 等. 2022年中国恶性肿瘤流行情况分析[J]. 中华肿瘤杂志, 2024, 46(3): 221-231. [Zheng RS, Chen R, Han BF, et al. Cancer incidence and mortality in China, 2022[J]. Chinese Journal of Oncology, 2024, 46(3): 221-231.] DOI: 10.3760/cma.j.cn112152-20240119-00035.
2.Bourreau C, Treps L, Faure S, et al. Therapeutic strategies for nonsmall cell lung cancer: experimental models and emerging biomarkers to monitor drug efficacies[J]. Pharmacol Ther, 2023, 242: 108347. DOI: 10.1016/j.pharmthera.2023.108347.
3.中国临床肿瘤学会非小细胞肺癌专家委员会. 驱动基因阴性非小细胞肺癌二线治疗中国专家共识 [J].中国肺癌杂志, 2024, 27(2): 81-87. DOI: 10.3779/j.issn. 1009-3419.2024.102.10.
4.吴昌金, 李汶檀, 陶红宇, 等. 非小细胞肺癌一线免疫治疗的药物经济学研究综述[J].医学与社会, 2023, 36(11): 94-100. [Wu CJ, Li WT, Tao HY, et al. Review of research on pharmacoeconomics of first-line immunotherapy for treating non-small cell lung cancer[J]. Medicine and Society, 2023, 36(11): 94-100.] DOI: 10.13723 / j.yxysh.2023.11.016.
5.中国临床肿瘤学会指南工作委员会, 编著. 非小细胞肺癌诊疗指南2023[M]. 北京: 人民卫生出版社, 2023: 1-162.
6.National Comprehensive Cancer Network. NCCN Clinical practice guidelines in oncology-non-small cell lung cancer(Version 3.2024)[EB/OL]. (2024-03-12) [2024-05-20]. http://www.nccn.org.
7.刘自力. 替雷利珠单抗在肺癌治疗的研究进展[J].临床肺科杂志, 2024, 29(4): 623-631. DOI: 10.3969/j.issn.1009-6663.2024.04.028.
8.李文萍, 邓平阳, 杨林. 右美托咪定用于ICU机械通气患者的快速卫生技术评估[J]. 药物流行病学杂志, 2024, 33(4): 441-448. [Li WP, Deng PY, Yang L, et al. Dexmedetomidine for sedation in the ICU patients on mechanical Ventilation:a rapid health technology assessment[J]. Chinese Journal of Pharmacoepidemiology, 2024, 33(4): 441-448.] DOI: 10.12173/j.issn.1005-0698. 202311046.
9.张方圆, 沈傲梅, 曾宪涛, 等.系统评价方法学质量评价工具AMSTAR 2解读[J].中国循证心血管医学杂志, 2018, 10(1): 14-18. [Zhang FY, Shen AM, Zeng XT, et al. An Introduction to AMSTAR 2: a critical appraisal tool for systematic reviews[J]. Chinese Journal of Evidence-Based Cardiovascular Medicine, 2018, 10(1): 14-18.] DOI: 10.3969/j.issn.1674-4055.2018.01.03.
10.陶立元, 甘戈, 刘珏. 卫生经济学评价报告标准2022解读[J].中华流行病学杂志, 2023, 44(4): 667-672. [Tao LY, Gan G, Liu J. Interpretation of Consolidated Health Economic Evaluation Reporting Standards 2022[J]. Chinese Journal of Epidemiology, 2023, 44(4): 667-672.] DOI: 10.3760/cma.j.cn112338-20221127-01002.
11.Liu L, Bai H, Wang C, et al. Efficacy and safety of first-line immunotherapy combinations for advanced NSCLC: a systematic review and network meta-analysis[J]. J Thorac Oncol, 2021, 16(7): 1099-1117. DOI: 10.1016/j.jtho.2021.03.016.
12.Siciliano MA, Caridà G , Ciliberto D, et al. Efficacy and safety of first-line checkpoint inhibitors-based treatments for non-oncogene-addicted non-small-cell lung cancer: a systematic review and meta-analysis[J]. ESMO Open, 2022, 7(3): 100465. DOI: 10.1016/j.esmoop.2022.100465.
13.Zhao M, Shao T, Ren Y, et al. Identifying optimal PD-1/ PD-L1 inhibitors in first-line treatment of patients with advanced squamous non-small cell lung cancer in China: updated systematic review and network meta-analysis[J]. Front Pharmacol, 2022, 13: 910656. DOI: 10.3389/fphar.2022.910656.
14.钟红, 孔文强, 邱洪波, 等. PD -1 抑制剂联合化疗对比化疗一线治疗晚期 NSCLC 有效性及安全性的网状Meta分析[J].中国新药与临床杂志, 2023, 42(6): 410-416. [Zhong H, Kong WQ, Qiu HB, et al. Comparative efficacy and safety of PD-1 inhibitors plus chemotherapy versus chemotherapy in first-line treatment of patients with advanced non-small cell cancer: a network meta-analysis[J]. Chinese Journal of New Drugs and Clinical Remedies, 2023, 42(6): 410-416.] DOI: 10.14109/j.cnki.xyylc.2023.06.14.
15.Chen W, Chen J, Zhang L, et al. Network meta-analysis of first-line immune checkpoint inhibitor therapy in advanced non-squamous non-small cell lung cancer patients with PD-L1 expression≥50%[J]. BMC Cancer, 2023, 23(1): 719. DOI: 10.1186/s12885-023-11285-4.
16.Messori A, Rivano M, Chiumente M, et al. Tislelizumab plus chemotherapy vs. pembrolizumab plus chemotherapy for the first-line treatment of advanced non-small cell lung cancer: systematic review and indirect comparison of randomized trials[J]. Chin Clin Oncol, 2022, 12(5): 50. DOI: 10.21037/cco-23-26.
17.Guo Y, Jia J, Hao Z, et al. Tislelizumab plus chemotherapy versus pembrolizumab plus chemotherapy for the first-line treatment of advanced non-small cell lung cancer: systematic review and indirect comparison of randomized trials[J]. Front Pharmacol, 2023, 14: 1172969. DOI: 10.3389/fphar.2023.1172969.
18.Luo X, Zhou Z, Zeng X, et al. The cost-effectiveness of tislelizumab plus chemotherapy for locally advanced or metastatic nonsquamous non-small cell lung cancer[J]. Front Pharmacol, 2022, 13: 935581. DOI: 10.3389/fphar.2022.935581.
19.Liang X, Chen X, Li H, et al. Tislelizumab plus chemotherapy is more cost-effective than chemotherapy alone as first-line therapy for advanced non-squamous non-small cell lung cancer[J]. Front Public Health, 2023, 11: 1009920. DOI: 10.3389/fpubh.2023.1009920.
20.Lu S, Wang J, Yu Y, et al. Tislelizumab plus chemotherapy as first-Line treatment for locally advanced or metastatic nonsquamous NSCLC (RATIONALE 304): a randomized phase 3 trial[J]. J Thorac Oncol, 2021, 16(9): 1512-1522. DOI: 10.1016/j.jtho.2021.05.005.