World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access
Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc
Journal website https://www.wjon.org

Original Article

Volume 15, Number 1, February 2024, pages 72-80

The Addition of Atezolizumab to Chemotherapy in Non-Small Cell Lung Cancer: A Trial-Based Review and Meta-Analysis

Figures

Figure 1.
Figure 1. PRISMA 2020 flow diagram. PRISMA: Preferred Reporting Items for Systematic Review and Meta Analyses.
Figure 2.
Figure 2. Meta-analysis of PD-L1 status subscale of OS score. OS: overall survival; PD-L1: programmed cell death-ligand 1.
Figure 3.
Figure 3. PFS analysis, with 95% CI on standardized mean difference. PFS: progression-free survival; CI: confidence interval.

Table

Table 1. Summary of the Included Studies’ Characteristics
 
StudyCriteria for eligibilityPatient/populationInterventionComparisonFollow-upOutcomesQuality score
NSCLC: non-small cell lung cancer; OS: overall survival; PFS: progression-free survival.
Socinski et al, 2021 [11]≥18 years old, chemotherapy naive802 patients stage IV NSCLCAtezolizumab: 1,200 mgBevacizumab: 15 mg/kg32.4 monthsImproved OS in the second intervention arm (19 months) than in the control arm (14.7 months).Jadad score 3: 1) Randomized: yes; 2) Randomized described: yes; 3) Double-blind: no; 4) Blinding described: no; 5) Withdrawals: yes
Stage IV metastatic non-squamous NSCLCCarboplatin: area under the concentration-time curve of 6 mg/mL/minCarboplatin: area under the concentration-time curve of 6 mg/mL/min
Available tumor tissue for biomarker testingPaclitaxel: 200 mg/m2 (for patients of Asian ethnicity, use 175 mg/m2)Paclitaxel: 200 mg/m2 (for patients of Asian ethnicity, use 175 mg/m2)Improved PFS in the first intervention arm (8.4months) than in the control arm (6.8 months).
Eastern Cooperative Oncology Group performance status of 0 or 1
Atezolizumab: 1,200 mg
Bevacizumab: 15 mg/kg
Carboplatin: area under the concentration-time curve of 6 mg/mL/min
Paclitaxel: 200 mg/m2 (for patients of Asian ethnicity, use 175 mg/m2)
Nishio et al, 2021 [10]≥ 18 years old578 patients stage IV NSCLCAtezolizumab: 1,200 mg (fixed dose) every 21 daysCisplatin: 75 mg/m2 every 21 days or32.4 monthsImproved OS in the intervention arm (18.1 months) than in the control arm (13.6 months). Improved PFS in the intervention arm (7.6 months) than in the control arm (5.2 months).Jadad score 3: 1) Randomized: yes; 2) Randomized described: yes; 3) Double-blind: no; 4) Blinding described: no; 5) Withdrawals: yes
Histologically or cytologically confirmed stage IV non-squamous NSCLCCisplatin: 75 mg/m2 every 21 days orCarboplatin: target area under the concentration-time curve of 6 mg/mL/min every 21 days
Treatment-free interval of greater than or equal to 6 months was required if patients had previous chemotherapy or radiotherapyCarboplatin: target area under the concentration-time curve of 6 mg/mL/min every 21 daysPemetrexed: 500 mg/m2 every 21 days
Eastern Cooperative Oncology Group performance status of 0 or 1Pemetrexed: 500 mg/m2 every 21 days
West et al, 2019 [8]≥ 18 years or older, and had histologically or cytologically confirmed stage IV non-squamous NSCLC723 patients stage IV NSCLCAtezolizumab: 1,200 mg/m2 intravenously every 3 weeksCarboplatin: area under the curve 6 mg/mL/min every 3 weeks18.5 monthsImproved OS in the intervention arm (18.6 months) than in the control arm (13.9 months). Improved PFS in the intervention arm (7 months) than in the control arm (5.5 months).Jadad score 3: 1) Randomized: yes; 2) Randomized described: yes; 3) Double-blind: no; 4) Blinding described: no; 5) Withdrawals: yes
Received no previous chemotherapy for stage IV diseaseCarboplatin: area under the curve 6 mg/mL/min every 3 weeksNab-paclitaxel: 100 mg/m2 intravenously every week
Eastern Cooperative Oncology Group performance status of 0 or 1Nab-paclitaxel: 100 mg/m2 intravenously every week
Rittmeyer et al, 2017 [9]≥18 years old1,225 patients stage IIIB-IV NSCLCAtezolizumab: 1,200 mg/m2 intravenously every 3 weeksDocetaxel: 75 mg/m2 every 3 weeks21 monthsImproved OS in intervention arm (13.8 months) than in control arm (9.6 months).Jadad score 3: 1) Randomized: yes; 2) Randomized described: yes; 3) Double-blind: no; 4) Blinding described: no; 5) Withdrawals: yes
Patients had received one to two previous cytotoxic chemotherapy regimens (≥ 1 platinum-based combination therapy) for stage IIIB or IV NSCLC
Eastern Cooperative Oncology Group performance status of 0 or 1