Therapeutic effects and associated adverse events of PD 1 and CTLA 4 pathway inhibitors in the treatment of non small cell lung cancer meta analyses of clinical phase II III randomized controlled trials
Objective: To summarize and compare the therapeutic efficacy of programmed death 1 (PD 1) and cytotoxic T lymphocyte associated antigen 4 (CTLA 4) pathway inhibitors in the treatment of non small cell lung cancer (NSCLC) Methods: Traditional and network meta analysis of clinical phase II/III randomized controlled trials of PD 1 and CTLA 4 pathway inhibitors vs. controls (general chemotherapy or best support therapy) in the treatment of NSCLC was performed by RevMan and ITC programs. The data of progression free survival (PFS) overall survival (OS) objective response rate (ORR) and grade 3/4 AE were extracted to evaluate the prognosis, tumor responses, and toxicity, respectively. Results: Among patients with NSCLC, when compared with controls, PD 1 pathway inhibitors had longer median OS, higher ORR, and lower incidence of grade 3 or 4 AE; further CTLA 4 pathway inhibitors had higher ORR. When compared with CTLA 4 pathway inhibitors, PD 1 pathway inhibitors had significant higher OS and lower incidence of grade 3 or 4 AE. Conclusion: Because the PD 1 pathway inhibitors have more advantages in patients' survival, tumor response, and adverse events than CTLA 4 pathway inhibitors and traditional treatment, this agents could prioritize to use for the treatment of NSCLC.