Rapid health technology assessment of PD-1/PD-L1 inhibitors for the treatment of patients with NSCLC_Chinese Journal of Evidence-Based Medicine

Authors：

GAO Xu , LU Chang , LI Ding , LIANG Yuwei , ZHENG Yuxuan , ZHANG Yuxian , AN Minghui ,  GONG Jian

Drug Epidemiology and Clinical Drug Evaluation Group, Shenyang Pharmaceutical University, Shenyang 110016, P. R. China;

Corresponding author：

GONG Jian, Email: fanxing1230@163.com

Keywords：

PD-1; PD-L1; NSCLC; Economic tudies; rHTA

DOI：

10.7507/1672-2531.202504148

Video：

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Objective To evaluate the efficacy, safety and economy of PD-1/PD-L1 inhibitors for non-small cell lung cancer (NSCLC), and to provide an evidence-based basis for clinical dosing and decision-making. Methods Computerized searches of PubMed, Embase, Cochrane Library, CNKI, WanFang Data, VIP and official websites of domestic and international health technology assessment (HTA) organizations were conducted to collect HTA reports, safety and economic data on the use of PD-1/PD-L1 inhibitors (nabulizumab, pembrolizumab, cimeplizumab, atilizumab, and duvarizumab) for NSCLC HTA reports, systematic reviews (SR)/Meta-analyses, and pharmacoeconomic studies, all with a search timeframe of March 2024 from the time of library construction. After data extraction and quality assessment, the results of the included studies were analyzed descriptively. Results A total of 16 papers were included, including 16 SR/Meta analyses and 2 pharmacoeconomic studies. Compared with first-line chemotherapy, PD-1/PD-L1 inhibitors increased the efficiency and disease control rate, prolonged the survival time, improved the quality of survival, and reduced grade 3-5 treatment-related adverse effects (including fatigue, dyspnea, anemia, pneumonia, severe skin reactions, nausea, diarrhea, decreased appetite, and leukopenia) in NSCLC patients. Cemiplizumab was cost-effective when the WTP threshold was $100 000/QALY, and pembrolizumab was cost-effective when the WTP threshold was $150 000/QALY. Conclusion PD-1/PD-L1 inhibitors (nabulizumab, pabolizumab, cimiplizumab, atilizumab, and duvarizumab) are efficacious, safe, and cost-effective for use in NSCLC; however, given the small number of pharmacoeconomic studies included, economic conclusions drawn need to be interpreted with caution.

1.	Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	伍家鸣, 王菁, 林丽珠, 等. 艾迪注射液联合一线化疗方案治疗非小细胞肺癌临床疗效的Meta分析. 中成药, 2017, 39(6): 1323-1328.
3.	中华医学会肿瘤学分会. 中华医学会肺癌临床诊疗指南(2024版). 中华医学杂志, 2024, 104(34): 3175-3213.
4.	李慧, 王俊彦, 王萌萌, 等. 康莱特注射液联合GP化疗方案对中晚期非小细胞肺癌治疗作用的Meta分析. 药物流行病学杂志, 2022, 31(6): 363-370.
5.	许聪聪, 黄柳绿, 唐姣, 等. 艾迪注射液联合一线化疗用于NSCLC的快速卫生技术评估. 中国药房, 2023, 34(10): 1247-1251.
6.	张欣, 高洁, 张慧勤, 等. PD-1/PD-L1抑制剂与非小细胞肺癌的临床研究进展. 医学研究杂志, 2022, 51(12): 173-177.
7.	宫建, 张灵健, 丁选胜, 等. 健康中国建设对临床药学专业学位研究生教学模式影响. 中国公共卫生, 2021, 37(11): 1718-1720.
8.	唐惠林, 门鹏, 翟所迪. 药物快速卫生技术评估方法及应用. 临床药物治疗杂志, 2016, 14(2): 1-4.
9.	李旭晗, 冼静怡, 杨燕, 等. 药物流行病学在临床药物评价中的应用. 医药导报, 2023, 42(9): 1368-1374.
10.	晏莉. 化疗联合免疫检查点抑制剂对比单纯化疗一线治疗晚期非小细胞肺癌疗效及安全性的Meta分析. 重庆: 重庆医科大学, 2020.
11.	Li Y, Liang X, Yang T, et al. Pembrolizumab vs. cemiplimab for the treatment of advanced non-small cell lung cancer with PD-L1 expression levels of at least 50%: a network meta-analysis and cost-effectiveness analysis. Front Oncol, 2022, 12: 878054.
12.	李晨露, 陈燕, 王心怡. PD-L1抑制剂治疗晚期非小细胞肺癌有效性与安全性的meta分析. 北京: 2016年中国药学大会暨第十六届中国药师周论文集. 2016: 328-335.
13.	钟红. PD-1抑制剂联合化疗对比化疗一线治疗晚期NSCLC有效性及安全性的网状Meta分析. 中国新药与临床杂志, 2023, 42(6): 356-362.
14.	刘贞. PD-1/PD-L1抑制剂与化疗治疗非小细胞肺癌疗效及安全性的meta分析. 南京: 东南大学, 2018.
15.	付鹏, 王超, 李翔, 等. PD-1/PD-L1抗体与多西紫杉醇治疗晚期非小细胞肺癌的总体疗效及安全性Meta分析. 肿瘤药学, 2019, 9(1): 155-159.
16.	Herbst R, Jassem J, Abogunrin S, et al. A network meta-analysis of cancer immunotherapies versus chemotherapy for first-line treatment of patients with non-small cell lung cancer and high programmed death-ligand 1 expression. Front Oncol, 2021, 11: 676732.
17.	You W, Liu M, Miao JD, et al. A network meta-analysis comparing the efficacy and safety of anti-PD-1 with anti-PD-L1 in non-small cell lung cancer. J Cancer, 2018, 9(7): 1200-1206.
18.	Peng TR, Lin HH, Tsai FP, et al. Immune checkpoint inhibitors for first-line treatment of advanced non-small-cell lung cancer: a systematic review and network meta-analysis. Thorac Cancer, 2021, 12(21): 2873-2885.
19.	Lu Y, Zhang X, Ning J, et al. Immune checkpoint inhibitors as first-line therapy for non-small cell lung cancer: a systematic evaluation and meta-analysis. Hum Vaccin Immunother. 2023, 19(1): 2169531.
20.	Liu Q, Zhou Z, Luo X, et al. First-line ICI monotherapies for advanced non-small-cell lung cancer patients with PD-L1 of at least 50%: a cost-effectiveness analysis. Front Pharmacol, 2021, 12: 788569.
21.	Wang L, Yang Y, Yu J, et al. Efficacy and safety of anti-PD-1/PD-L1 in combination with chemotherapy or not as first-line treatment for advanced non-small cell lung cancer: a systematic review and network meta-analysis. Thorac Cancer, 2022, 13(3): 322-337.
22.	Wang DD, Shaver LG, Shi FY, et al. Comparative efficacy and safety of PD-1/PD-L1 immunotherapies for non-small cell lung cancer: a network meta-analysis. Eur Rev Med Pharmacol Sci, 2021, 25(7): 2866-2884.
23.	Jiang M, Liu C, Ding D, et al. Comparative efficacy and safety of anti-PD-1/PD-L1 for the treatment of non-small cell lung cancer: a network meta-analysis of 13 randomized controlled studies. Front Oncol, 2022, 12: 827050.
24.	Khan M, Lin J, Liao G, et al. Comparative analysis of immune checkpoint inhibitors and chemotherapy in the treatment of advanced non-small cell lung cancer: a meta-analysis of randomized controlled trials. Medicine (Baltimore), 2018, 97(33): e11936.
25.	Ramos-Esquivel A, van der Laat A, Rojas-Vigott R, et al. Anti-PD-1/anti-PD-L1 immunotherapy versus docetaxel for previously treated advanced non-small cell lung cancer: a systematic review and meta-analysis of randomised clinical trials. ESMO Open, 2017, 2(3): e000236.

1. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. 伍家鸣, 王菁, 林丽珠, 等. 艾迪注射液联合一线化疗方案治疗非小细胞肺癌临床疗效的Meta分析. 中成药, 2017, 39(6): 1323-1328.
3. 中华医学会肿瘤学分会. 中华医学会肺癌临床诊疗指南(2024版). 中华医学杂志, 2024, 104(34): 3175-3213.
4. 李慧, 王俊彦, 王萌萌, 等. 康莱特注射液联合GP化疗方案对中晚期非小细胞肺癌治疗作用的Meta分析. 药物流行病学杂志, 2022, 31(6): 363-370.
5. 许聪聪, 黄柳绿, 唐姣, 等. 艾迪注射液联合一线化疗用于NSCLC的快速卫生技术评估. 中国药房, 2023, 34(10): 1247-1251.
6. 张欣, 高洁, 张慧勤, 等. PD-1/PD-L1抑制剂与非小细胞肺癌的临床研究进展. 医学研究杂志, 2022, 51(12): 173-177.
7. 宫建, 张灵健, 丁选胜, 等. 健康中国建设对临床药学专业学位研究生教学模式影响. 中国公共卫生, 2021, 37(11): 1718-1720.
8. 唐惠林, 门鹏, 翟所迪. 药物快速卫生技术评估方法及应用. 临床药物治疗杂志, 2016, 14(2): 1-4.
9. 李旭晗, 冼静怡, 杨燕, 等. 药物流行病学在临床药物评价中的应用. 医药导报, 2023, 42(9): 1368-1374.
10. 晏莉. 化疗联合免疫检查点抑制剂对比单纯化疗一线治疗晚期非小细胞肺癌疗效及安全性的Meta分析. 重庆: 重庆医科大学, 2020.
11. Li Y, Liang X, Yang T, et al. Pembrolizumab vs. cemiplimab for the treatment of advanced non-small cell lung cancer with PD-L1 expression levels of at least 50%: a network meta-analysis and cost-effectiveness analysis. Front Oncol, 2022, 12: 878054.
12. 李晨露, 陈燕, 王心怡. PD-L1抑制剂治疗晚期非小细胞肺癌有效性与安全性的meta分析. 北京: 2016年中国药学大会暨第十六届中国药师周论文集. 2016: 328-335.
13. 钟红. PD-1抑制剂联合化疗对比化疗一线治疗晚期NSCLC有效性及安全性的网状Meta分析. 中国新药与临床杂志, 2023, 42(6): 356-362.
14. 刘贞. PD-1/PD-L1抑制剂与化疗治疗非小细胞肺癌疗效及安全性的meta分析. 南京: 东南大学, 2018.
15. 付鹏, 王超, 李翔, 等. PD-1/PD-L1抗体与多西紫杉醇治疗晚期非小细胞肺癌的总体疗效及安全性Meta分析. 肿瘤药学, 2019, 9(1): 155-159.
16. Herbst R, Jassem J, Abogunrin S, et al. A network meta-analysis of cancer immunotherapies versus chemotherapy for first-line treatment of patients with non-small cell lung cancer and high programmed death-ligand 1 expression. Front Oncol, 2021, 11: 676732.
17. You W, Liu M, Miao JD, et al. A network meta-analysis comparing the efficacy and safety of anti-PD-1 with anti-PD-L1 in non-small cell lung cancer. J Cancer, 2018, 9(7): 1200-1206.
18. Peng TR, Lin HH, Tsai FP, et al. Immune checkpoint inhibitors for first-line treatment of advanced non-small-cell lung cancer: a systematic review and network meta-analysis. Thorac Cancer, 2021, 12(21): 2873-2885.
19. Lu Y, Zhang X, Ning J, et al. Immune checkpoint inhibitors as first-line therapy for non-small cell lung cancer: a systematic evaluation and meta-analysis. Hum Vaccin Immunother. 2023, 19(1): 2169531.
20. Liu Q, Zhou Z, Luo X, et al. First-line ICI monotherapies for advanced non-small-cell lung cancer patients with PD-L1 of at least 50%: a cost-effectiveness analysis. Front Pharmacol, 2021, 12: 788569.
21. Wang L, Yang Y, Yu J, et al. Efficacy and safety of anti-PD-1/PD-L1 in combination with chemotherapy or not as first-line treatment for advanced non-small cell lung cancer: a systematic review and network meta-analysis. Thorac Cancer, 2022, 13(3): 322-337.
22. Wang DD, Shaver LG, Shi FY, et al. Comparative efficacy and safety of PD-1/PD-L1 immunotherapies for non-small cell lung cancer: a network meta-analysis. Eur Rev Med Pharmacol Sci, 2021, 25(7): 2866-2884.
23. Jiang M, Liu C, Ding D, et al. Comparative efficacy and safety of anti-PD-1/PD-L1 for the treatment of non-small cell lung cancer: a network meta-analysis of 13 randomized controlled studies. Front Oncol, 2022, 12: 827050.
24. Khan M, Lin J, Liao G, et al. Comparative analysis of immune checkpoint inhibitors and chemotherapy in the treatment of advanced non-small cell lung cancer: a meta-analysis of randomized controlled trials. Medicine (Baltimore), 2018, 97(33): e11936.
25. Ramos-Esquivel A, van der Laat A, Rojas-Vigott R, et al. Anti-PD-1/anti-PD-L1 immunotherapy versus docetaxel for previously treated advanced non-small cell lung cancer: a systematic review and meta-analysis of randomised clinical trials. ESMO Open, 2017, 2(3): e000236.

Chinese Journal of Evidence-Based Medicine

Latest ArticlesRapid health technology assessment of PD-1/PD-L1 inhibitors for the treatment of patients with NSCLC

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