A Comparison of nivolumab and pembrolizumab for advanced NSCLC in the second-line treatment: A Systematic Review and Network Meta-analysis

Abstract Objectives : As reported, nivolumab and pembrolizumab have shown to be superior to docetaxel in advanced NSCLC. Therefore, we performed a systematic review and network meta-analysis to compare the efficacy and safety of nivolumab and pembrolizumab. Materials and Methods : Randomized controlled trials (RCTs) assessing the effect and safety of nivolumab or pembrolizumab versus docetaxel for patients with advanced NSCLC in the second-line treatment were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. After that, we performed pairwise direct meta-analyses (nivolumab vs. docetaxel and pembrolizumab vs. docetaxel) and indirect comparison (nivolumab vs. pembrolizumab) using network meta-analyses methods. Results : Four RCTs involving 2391 patients were included in the meta-analysis. In analyses of overall survival (OS), progression-free survival (PFS) and overall response rate (ORR) in the direct meta-analysis, nivolumab and pembrolizumab both showed survival benefits when compared with docetaxel. For the indirect comparison, nivolumab show no signifcant difference in OS, PFS and ORR when compared with pembrolizumab (OS: HR 1.03; 95% CI 0.84–1.26; PFS: HR 0.95; 95% CI 0.80–1.14; ORR: HR 1.08; 95% CI 0.67–1.73). For the safety analysis, nivolumab and pembrolizumab both have less toxicity than docetaxel. In indirect comparison, nivolumab showed less all-grade toxicity (OR 0.71; 95% CI 0.49–1.04) and grade 3–5 toxicity (OR 0.32; 95% CI 0.21–0.49) when compared with pembrolizumab.Conclusion : Our meta-analysis suggests that nivolumab and pembrolizumab demonstrated similar clinical benefit for patients with advanced NSCLC in the second-line treatment. It seems that nivolumab has less toxicity when compared with pembrolizumab.