Smoking and EGFR status may predict outcomes of advanced NSCLC treated with PD-(L)1 inhibitors beyond first line: A meta-analysis.

OBJECTIVES: The aim of this study was to assess the potential clinical and biological predictive markers of survival in pretreated advanced NSCLC patients treated with the three PD-(L)1 inhibitors (nivolumab, pembrolizumab and atezolizumab).

DATA SOURCE/STUDY SELECTION: PubMed database has been searched. The review author extracted relevant information on participant characteristics and study outcomes for this review and assessed risk of bias of the included trials. Data analysis was conducted through RevMan v.5.3.

MAIN RESULTS: Five randomized controlled trials with 3013 patients were included. There was no predictive value for the age of the patients (taking 65 years as a cutoff value), the histology (squamous vs nonsquamous) or performance score (score 0 vs score 1); while there appears to be a value for smoking history and EGFR status. The pooled HR for death for patients with EGFR mutant disease was 1.11 [95% CI: 0.80, 1.53; P = 0.54]; while pooled HR for death for patients with EGFR wild type disease was 0.67 [95% CI: 0.60, 0.75; P < 0.00001]. The pooled HR for death for patients with current/former smokers was 0.71 [95% CI: 0.63, 0.82; P < 0.00001]; while pooled HR for death for patients with never smokers was 0.79 [95% CI: 0.60, 1.06; P = 0.11]. However, because of the low-to-moderate quality of data, these conclusions may change with publication of other ongoing trials.

CONCLUSIONS: Smoking history and EGFR status may help predict the performance of PD-(L)1 inhibitors vs docetaxel in previously treated NSCLC patients.