The efficacy of nivolumab for the treatment of advanced non-small cell lung cancer: a systematic review and meta-analysis of clinical trials

The aim of this study was to reevaluate the therapeutic effects of nivolumab for advanced non-small cell lung cancer (NSCLC) at a standard dose (3 mg/kg) in terms of the short-term response and long-term survival using a meta-analysis. Electronic databases were searched for eligible literature. Data for the objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS) and overall survival (OS) were extracted. The outcomes were synthesized based on a random effects model. Subgroup analyses were proposed. Eight studies involving 400 advanced NSCLC patients using nivolumab monotherapy were eligible. Overall, the ORR was 21.3% (95% CI 17.0%-26.4%), while the DCR was 39.9% (95% CI 26.5%-55.1%). Additionally, the rates of 6-month PFS, 1-year PFS, 6-month OS and 1-year OS were 34.5% (95% CI 27.6%-42.1%), 22.3% (95% CI 17.8%-27.4%), 63.6% (95% CI 57.8%-68.9%) and 49.8% (95% CI 38.5%-61.1%), respectively. Subgroup analyses demonstrated that the ORR and DCR in Phase 1 trials were greater than those in Phase 2 and 3 trials. In addition, the ORR and DCR in patients with squamous cell carcinoma (SQCC) were lower than those in patients with non-SQCC. PD-1 ligand 1 (PD-L1)-positive patients were associated with a numerically higher ORR compared with PD-L1-negative patients, but this difference was not significant (OR 1.702, 95% CI 0.891-3.253). In conclusion, nivolumab exhibited a favorable efficacy for the treatment of patients with advanced NSCLC both in short-term responses and long-term survival.