Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2024

Immune checkpoint inhibitors +/- chemotherapy for patients with NSCLC and BM: a systematic review and network meta-analysis (#387)

Lauren Julia Brown 1 2 3 4 , Nicholas Yeo 5 , Harriet Gee 4 6 , Ines Pires da Silva 2 3 7 , Ben Y Kong 5 8 , Eric Hau 3 4 6 , Adnan Nagrial 2 3 9
  1. Department of Medical Oncology, Westmead Hospital, Westmead, NSW, Australia
  2. Department of Medical Oncology , Blacktown Hospital, Blacktown, Australia
  3. University of Sydney, Camperdown, New South Wales, Australia, Camperdown, NSW, Australia
  4. Radiation Biology and Translational Oncology Group, Westmead Institute for Medical Research, Westmead, NSW, Australia
  5. Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Australia
  6. Sydney West Radiation Oncology Network (SWRON), Westmead Hospital, Westmead, NSW, Australia
  7. Melanoma Institute Australia, Wollstonecraft, NSW, Australia
  8. SPHERE Cancer Clinical Academic Group , University of New South Wales, Sydney, NSW, Australia
  9. Department of Medical Oncology, Westmead Hospital, Westmead, NSW, Australia

Background: Data regarding immunotherapy efficacy for patients with metastatic NSCLC and brain metastases (BM) are limited and represent a small subset of the clinical trial population. Phase II studies have demonstrated intracranial efficacy of immune-checkpoint inhibitors (ICI) +/- chemotherapy [1-3]. The efficacy of chemotherapy and ICI combinations compared to ICI alone in patients with metastatic NSCLC with BM remains unknown.

Methods: A systematic review and network meta-analysis were performed (PROSPERO-CRD42024501345). The objective of this study was to evaluate ICI efficacy in metastatic NSCLC and BM and the influence of additional chemotherapy on survival outcomes. Randomised phase II/III studies with at least one treatment arm with an ICI were eligible for inclusion. The target population was treatment-naïve metastatic NSCLC. Efficacy results including OS and PFS in the subpopulation of patients with and without BM were assessed.

Results: Ten studies were included, totalling 6,560 patients, of whom 770 had BM. Pairwise meta-analysis revealed that patients with BM treated with ICI +/- chemotherapy had improved PFS (HR 0.49; 95% CI 0.39-0.60) and OS (HR 0.55; 95%CI 0.44-0.68) versus chemotherapy alone. Patients without BM treated with ICI +/- chemotherapy also improved PFS (HR 0.60; 95% CI 0.52-0.68) and OS (HR 0.72; 95% CI 0.66-0.78).

In the network meta-analysis of patients with BM, combination ICI with chemotherapy demonstrated improved PFS compared to ICI alone (HR 0.64; 95% CI 0.43-0.96; p=0.03). However, no significant difference was observed in OS between the two treatments (HR 0.99; 95% CI 0.56-1.74; p=0.97). Conversely, in the population of patients without BM, no significant differences in either PFS (HR 1.09; 95% CI 0.82-1.44; p=0.56) or OS (HR 0.99; 95% 0.81-1.20; p=0.92) were observed between ICI and chemotherapy group versus ICI alone.

Conclusion: Combination chemoimmunotherapy offers PFS benefit over ICI in BM patients, warranting direct comparisons in clinical trials.

 

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  2. Hou, X., C. Zhou, G. Wu, W. Lin, Z. Xie, H. Zhang, J. Yi, Z. Peng, L. Yin, C. Ma, et al., Efficacy, Safety, and Health-Related Quality of Life With Camrelizumab Plus Pemetrexed and Carboplatin as First-Line Treatment for Advanced Nonsquamous NSCLC With Brain Metastases (CAP-BRAIN): A Multicenter, Open-Label, Single-Arm, Phase 2 Study. Journal of Thoracic Oncology, 2023. 18(6): p. 769-779.DOI: 10.1016/j.jtho.2023.01.083.
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