Pembrolizumab plus chemotherapy for first-line treatment of metastatic nonsquamous non-small-cell lung cancer: a network meta-analysis

Aim: A systematic review and network meta-analysis were conducted to evaluate the efficacy of pembrolizumab+pemetrexed+platinum relative to other regimens in metastatic nonsquamous non-small-cell lung cancer (NSq-NSCLC). Patients & methods: Eligible studies evaluated first-line regimens in NSq-NSCLC patients without known targetable mutations. Relative treatment effects were synthesized with random effects proportional hazards Bayesian network meta-analyses. Results: The hazard ratio (HR) for overall survival (OS) for pembrolizumab+pemetrexed+platinum was statistically significant over all platinum-doublet (HR range: 0.42-0.61), platinum-doublet+bevacizumab (HR range: 0.44-0.53) and platinum-doublet+atezolizumab regimens (HR range: 0.56-0.62). Additionally, pembrolizumab+pemetrexed+platinum numerically improved OS over atezolizumab+paclitaxel+carboplatin+bevacizumab (HR: 0.65; 95% credible interval: 0.43, 1.01). Pembrolizumab+pemetrexed+platinum had 95.6% probability of being the best treatment regimen for OS. Conclusion: Pembrolizumab+pemetrexed+platinum is likely the most efficacious first-line regimen for metastatic NSq-NSCLC.