Advancements in Immunotherapy for Lung Cancer: A Meta‐Analysis of Clinical Trial Outcomes
Abstract
Immune checkpoint inhibitors (ICIs) have changed therapeutic selections for advanced non–small cell lung cancer (NSCLC). However, comparative evidence versus chemotherapy through ICI monotherapy and chemo‐immunotherapy combination strategies remains incomplete. For this purpose, we conducted a meta‐analysis of randomized controlled trials (RCTs) to measure overall survival (OS) and progression‐free survival (PFS) outcome improvements in ICI monotherapy or ICI‐chemotherapy combined treatment. These interventions take place in adults (≥ 18 years) with advanced/metastatic NSCLC. The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses directions were obeyed. PubMed, Scopus, and Web of Science were searched (2021–2024) for RCTs. A total of 7849 articles were retrieved. RCTs (n = 17) qualify inclusion. Hazard ratios (HRs) along with 95% confidence intervals (CIs) for OS and PFS were pooled using random‐effects models. The heterogeneity was assessed by I2. Risk of bias was valued with RoB 2. Publication bias and leave‐one‐out sensitivity analyses were also estimated. ICI monotherapy RCTs (n = 5) significantly enhanced OS (pooled HR = 0.73, 95% CI: 0.64–0.85; p < 0.0001) and PFS (pooled HR = 0.69, 95% CI: 0.49–0.96) with increased heterogeneity (I2 = 90%). Combined ICI‐chemotherapy RCTs (n = 12) produced great benefits, with a pooled OS (HR = 0.68, 95% CI: 0.61–0.75; p < 0.00001; I2 = 48%) and pooled PFS (HR = 0.55, 95% CI: 0.50–0.61; p < 0.00001; I2 = 56%). Subgroup analyses proposed durable effects in smaller trials and with pembrolizumab‐based treatments. Risk‐of‐bias valuations underlined concern, primarily for deviations from therapeutic interventions. Sensitivity analyses set robustness, whereas publication bias was limited. ICI‐based remedies, especially chemo‐immunotherapy, significantly improve OS and PFS. Heterogeneity and experimental‐level bias warrant cautious interpretation. Hence, large RCTs are important to choose the best treatment possibility.