SYSTEMATIC REVIEW article
Front. Oncol.
Sec. Cancer Immunity and Immunotherapy
This article is part of the Research TopicCombination Cancer Therapies and Systems ImmunologyView all articles
First-Line Immunochemotherapy for Advanced NSCLC in Asian Patients: A Meta-Analysis of Phase 3 RCTs
Provisionally accepted
- 1Jiangxi Provincial People's Hospital, Nanchang, China
- 2The Second Affiliated Hospital of Jiujiang University, Jiujiang, China
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Background: PD-1/PD-L1 inhibitors plus chemotherapy (PC) is now broadly acknowledged as effective for treating stage IIIb-IV non-small cell lung cancer (NSCLC). However, data specific to Asian populations remain limited, and updated evidence from randomized controlled trials (RCTs) is warranted. In this study, the efficacy and safety of PC are analyzed and compared with those of chemotherapy in this population. Methods: Six databases were systematically explored to locate applicable phase 3 RCTs. Eligible studies involved Asian patients with stage IIIb-IV NSCLC and compared PC treatment with conventional chemotherapy. Overall survival (OS) and progression-free survival (PFS) were regarded as primary endpoints. Results: A total of 16 phase 3 RCTs involving 4452 Asian patients were included. Compared with chemotherapy alone, PC significantly improved OS (HR: 0.68 [0.63, 0.75], p < 0.00001, I2 = 30%), and PFS (HR: 0.50 [0.47, 0.54], p < 0.00001, I2 = 39%). The survival benefits were consistent across most subgroups and increased as survival time increased. The objective response rate (RR: 1.62 [1.51, 1.74], P < 0.00001, I2 = 0%) and disease control rate (RR: 1.09 [1.05, 1.12], P < 0.00001, I2 = 7%) were also better in the PC group. Brain metastasis and a PD-L1 CPS > 50% were favorable factors in the PC group. However, more immune-related AEs (irAEs) were found in the PC group. Conclusion: Among Asian patients with stage IIIb-IV NSCLC, PC therapy still has a notable advantage in prolonging survival. Nonetheless, the increased frequency of AEs, particularly irAEs, warrants close attention.
Keywords: PD-1/PD-L1 inhibitors, chemotherapy, asian, non-small-cell lung cancer, Meta-analysis
Received: 20 Sep 2025; Accepted: 31 Oct 2025.
Copyright: © 2025 Mao, Zhang, Song, He, Zheng and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Wenquan Liu, liuwenquan321@163.com
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