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.

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