Summary of findings 1. Single‐immune checkpoint inhibitors (ICIs) compared to chemotherapy for people with advanced non‐small cell lung cancer (NSCLC).
| Single immune checkpoint inhibitors compared to chemotherapy for people with advanced non‐small cell lung cancer | |||||||
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Patient or population: People with advanced non‐small cell lung cancer Setting: Hospital Intervention: Single immune checkpoint inhibitors Comparison: First‐line, platinum‐based chemotherapy | |||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | ||
| Risk with chemotherapy | Risk with Single immune checkpoint inhibitors | ||||||
| Overall survival (OS) | by PD‐L1 expression ≥ 50% | 470 per 1000 | 130 more per 1000 (90 more to 170 more) |
HR 0.68 (0.60 to 0.76) |
2111 (6 studies) |
Moderate1 ⊕⊕⊕⊝ |
Data from Carbone 2017 and Rizvi 2020 used to estimate the anticipated effect at 12 month. |
| Progression‐free survival (PFS) | PD‐L1 expression ≥ 50% | 50 per 1000 |
80 more per 1000 (20 more to 150 more) |
HR 0.68, (0.51 to 0.88) |
1886 (5 studies) |
Low1,2 ⊕⊕⊝⊝ |
Data from Mok 2019; Reck 2016; Herbst 2020 used to estimate the anticipated effect at 12 months |
| Overall response rate (ORR) | PDL1 expression ‐ PDL1≥50% | 287 per 1000 |
115 more per 1,000 (34 more to 215 more) |
RR 1.40, (1.12 to 1.75) |
1672 (4 studies) |
Low1,2 ⊕⊕⊝⊝ |
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| Adverse Events grade 3‐4 | 414 per 1,000 |
244 fewer per 1,000 (217 fewer to 207 fewer) |
RR 0.41 (0.33 to 0.50) |
3346 (5 studies) |
Low1,2 ⊕⊕⊝⊝ |
Data presented as overall pooled result, as data were not available for this outcome by PD‐L1 expression or by TMB | |
| QOL‐C30 GHS/QOL (range 0‐100) ‐ change from baseline to week 15 | by PDL1 expression ‐ PDL1≥50% | 265 per 1,000 |
135 more per 1,000 (21 more to 146 more) |
RR 1.51 (1.08 to 2.10) |
297 (1 study) |
Low1,3 ⊕⊕⊝⊝ |
A high score indicates a good quality of life. |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; HR: Hazard ratio; RR: Risk ratio | |||||||
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GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect. | |||||||
1Downgraded one point due to risk of other bias (Carbone 2017 differences in baseline characteristics; Mok 2019 several protocol amendments), performance bias (Carbone 2017, Hellmann 2018, Reck 2016, Rizvi 2020, Sezer 2020), or of attrition bias (Hellmann 2018 and Rizvi 2020).
2Downgraded one point due to inconsistency.
3Downgraded one point due to imprecision. Results come from one single trial with relatively small sample size, or the confidence interval includes both clinically relevant values and clinically irrelevant values, thus limiting confidence to draw conclusions on an apparent lack of effect or a possible relevant effect.