Meta-analysis of immune checkpoint inhibitors for advanced EGFR-mutated non-small cell lung cancer after progression on EGFR tyrosine kinase inhibitors

There is no consensus on the clinical benefits of immune checkpoint inhibitor (ICI)-based treatments for patients with advanced EGFR-mutated non-small cell lung cancer (NSCLC) who have progressed on EGFR tyrosine kinase inhibitors (TKIs). A systematic review, meta-analysis, and network meta-analysis identified 17 single-arm trials and 15 randomized trials published before January 31, 2024, involving 2886 patients and seven ICI-based treatment strategies. Pairwise meta-analysis showed that, compared with chemotherapy, ICI monotherapy led to shorter progression-free survival (HR 1.73; 95% CI 1.30-2.29), whereas ICI plus antiangiogenesis plus chemotherapy (0.54; 0.44-0.67) and ICI plus chemotherapy (0.77; 0.67-0.88) prolonged PFS. Network meta-analysis showed that ICI-antiangiogenesis-chemotherapy yielded the best PFS results, with substantial benefits over ICI-chemotherapy (HR 0.71; 95% CrI 0,59-0,85),ICI monotherapy (0.30; 0.22-0.41), and non-ICI treatment strategies. The authors conclude that for patients with advanced EGFR-mutated NSCLC progressing on EGFR TKI, the combination of ICI-antiangiogenesis-chemotherapy is the optimal treatment option, with acceptable toxicity.