PQA 01 - PQA 01 Lung Cancer/Thoracic Malignancies and Diversity, Equity and Inclusion in Healthcare Poster Q&A
2148 - The Risk and Survival Significance of Immunotherapy and Targeted Therapy in Patients with Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
B. A. Tamene1,2, Y. Meng1, Z. Danyang1, and F. M. Kong1,3; 1Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong, 2Woldia University, Woldia, Ethiopia, 3Department of Clinical Oncology, Hong Kong University Shenzhen Hospital, Shenzhen, China
Purpose/Objective(s): We hypothesized that systemic immunotherapy and/or targeted therapy may have a higher risk of infections which could have a significant effect on the survival with non-small cell lung cancer (NSCLC). This study aimed to investigate the risk of all grades of infections and infections associated adverse events in patients with NSCLC who received immunotherapy and/or targeted therapy, as well as the impact on the patients survival outcomes. Materials/
Methods: This is a meta-analysis of published prospective studies. PubMed/Medline, EBASE, Cochrane Library, and other databases were searched using MeSH terms. Eligibility included patients with NSCLC treated with immunotherapy and/or targeted therapy under randomized clinical trials (Phase II or III), published in English (onwards 2015). The primary endpoint was the relative risk (RR) of any grade of infection including, pneumonia, sepsis/septic shock, respiratory tract infection (RTIs), urinary tract infections (UTIs), and febrile neutropenic. The pooled RR was estimated. Random-effect model was used if the heterogeneity(I2)=50%. Sub-group analysis was performed to explore sources of heterogeneity. STATA version 18 software was used for all analysis. Results: A total of 45 RCT studies (24852 patients) met the selection criteria. The overall RR of all grade infections was 1.23, 95%CI; (1.06-1.43, p=0.008). 2046 out of 13650 patients (14.99%, 95%CI:14.39-15.59) had any grade of infections in the treatment group versus 1410/11202(12.6%, 95%CI:11.98-13.22) of the control group. Among these cases with infection, 59 patients (2.9%) in the treatment group and 48 (3.4%) patients in the control group died because of the infections, there was no significant difference between the two groups p<0.05. The risk ratios for pneumonia were found to be 1.21 (95 CI%: 1.06-1.37), sepsis/septic shock 1.12 (95% CI: 0.74-1.71), Febrile neutropenic 1.26 (95%CI: 0.73-2.19), UTIs 1.34 (95%CI:1.09-1.66), RTIs and other infections 1.25 (95%:1.03-1.5). Subgroup analysis demonstrated the following treatment had a higher RR of infection: immunotherapy plus chemotherapy 2.05 (95% CI 1.45-2.9), targeted therapy plus chemotherapy 1.53 (95 %CI 1.04-2.26), PD-L1 inhibitors 1.57 (95% CI 1.21-2.03), EGFR inhibitors 1.03 (95% CI 1.27-2.10), and stage IV disease 1.31(95% CI 1.03-1.67). Conclusion: Patients with NSCLC had a 15% risk of infection with an overall risk ratio of 1.23 after immunotherapy and /or targeted therapy with or without combination of chemotherapy. Specifically, pneumonia, RTIs, and UTIs were found Statistical significant. Combination with chemotherapy, PD-L1 drug, and stage IV diseases were associated with a higher risk of infection. Further studies are still needed to explore the dynamic interaction of antitumor therapy and infections in NSCLC patients.