Optimum immunotherapy method according to PD-L1 expression in advanced lung cancer: a network meta-analysis

Aim: To compare the survival of advanced lung cancer patients treated with immune checkpoint inhibitors in different PD-L1 expression. Methods: We performed a network meta-analysis based on 25 trials involving 12,224 patients with different PD-L1 expression levels. Results: The results showed platinum-based chemotherapy plus pembrolizumab or nivolumab and ipilimumab was associated with the best survival rates for patients with <1% PD-L1 expression, while only platinum-based chemotherapy plus pembrolizumab produced better survival than chemotherapy in patients with 1-49% PD-L1 expression. As for patients with >= 50% PD-L1 expression, platinum-based chemotherapy plus pembrolizumab/atezolizumab and pembrolizumab/cemiplimab monotherapy were associated with better survival than chemotherapy. Conclusion: These results provide reference for selecting the optimum immunotherapy method based on the expression of PD-L1 in patients with advanced lung cancer. Lay abstract Lung cancer has a high incidence and mortality rate, and there are many treatment strategies, including surgery, chemotherapy, targeted therapy and immunotherapy. The emergence of immunotherapy has effectively improved the treatment effect of lung cancer, but different immunotherapy strategies and drugs have inconsistent efficacy in different patients. In this study the expression of PD-L1 was used to differentiate patients, and the survival difference of patients receiving different immunotherapy strategies was explored through statistical methods. This study may help clinicians choose the best immunotherapy methods and drugs for different patients. Systematic review registration: PROSPERO CRD42020186947.