Enhanced efficacy of lung cancer treatment with radiotherapy and immune checkpoint inhibitors without increased pneumonia risk: a systematic review and meta-analysis of randomized controlled trials
Abstract
Objective Combined modality treatment with chemotherapy, radiotherapy, and immunotherapy is a crucial therapeutic approach for lung cancer. However, controversies still exist regarding radiation doses, treatment regimens, and the risk of pneumonitis. This study aimed to conduct a comprehensive meta-analysis and in-depth subgroup analyses based on randomized controlled trials (RCTs) involving lung cancer patients undergoing radiotherapy to assess whether its combination with immunotherapy is effective and safe. Methods We systematically searched PubMed, Cochrane Central, Embase, and major conferences for randomized trials evaluating immune checkpoint inhibitors (ICIs) plus radiotherapy in lung cancer. The outcomes included progression-free survival (PFS), overall survival (OS), and the incidence of adverse reactions, particularly focusing on pneumonitis/pneumonia. Subgroup analyses were performed based on radiotherapy modalities, the timing of ICIs treatment, tumor stage, pathological type, and types of ICIs. Results Fifteen trials were included in this analysis. The addition of ICIs to radiotherapy or chemoradiotherapy significantly improved PFS (HR = 0.76, 95% CI 0.70–0.83) and OS (HR = 0.83, 95% CI 0.75–0.92). In subgroup analyses, stereotactic body radiotherapy (SBRT) (HR = 0.38, 95% CI 0.19-0.75) and hypo-fractionated radiotherapy (Hypo-RT) (HR = 0.49, 95% CI 0.31-0.79) were associated with improved PFS. Consolidation ICIs treatment improved OS (HR = 0.68, 95% CI…
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