Majem, MargaritaCobo, ManuelIsla, DoloresMarquez-Medina, DiegoRodriguez-Abreu, DelvysCasal-Rubio, JoaquinMoran-Bueno, TeresaBernabe-Caro, ReyesPerez-Parente, DiegoRuiz-Gracia, PedroArroyo, Marta MarinaPaz-Ares, Luis2023-02-092023-02-092021-03-26Majem M, Cobo M, Isla D, Marquez-Medina D, Rodriguez-Abreu D, Casal-Rubio J, et al. PD-(L)1 Inhibitors as Monotherapy for the First-Line Treatment of Non-Small-Cell Lung Cancer Patients with High PD-L1 Expression: A Network Meta-Analysis. J Clin Med. 2021 Mar 26;10(7):13652077-0383http://hdl.handle.net/10668/17524Programmed cell death-ligand 1 (PD-L1) has emerged as a potential biomarker for selection of patients more likely to respond to immunotherapy and as a prognostic factor in non-small cell lung cancer (NSCLC). In this network meta-analysis, we aimed to evaluate the efficacy of first-line anti-PD-(L)1 monotherapy in advanced NSCLC patients with high PD-L1 expression (≥50%) compared to platinum-based chemotherapy. We also evaluated efficacy outcomes according to tumor mutational burden (TMB). To that end, we conducted a systematic review. Six clinical trials with 2111 patients were included. In head-to-head comparisons, immunotherapy showed a significant improvement in progression-free survival (PFS: HRpooled = 0.69, 95% CI: 0.52-0.90, p = 0.007), overall survival (OS: HRpooled = 0.69, 95% CI: 0.61-0.78; p< 0.001) and overall response rate (ORR) (Risk ratio (RR)pooled = 1.354, 95% CI: 1.04–1.762, p = 0.024). In the assessment of relative efficacy for PFS through indirect comparisons, pembrolizumab (results from KEYNOTE-024) ranked highest followed by cemiplimab and atezolizumab, with statistical significance determined for some of the drugs. In terms of OS, cemiplimab ranked highest followed by atezolizumab and pembrolizumab, although non-significant OS was determined for these drugs. In conclusion, PD-(L)1 inhibitor monotherapy improves efficacy outcomes in the first line setting of advanced NSCLC patients with high PD-L1 expression. Evaluations with longer follow up are still needed to determine the superiority of any specific drug.enAttribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/PD-(L)1 inhibitorsEfficacyFirst-line treatmentImmunotherapyNetwork meta-analysisNon-small cell lung cancerLung NeoplasmsProgression-Free SurvivalImmune Checkpoint InhibitorsPrognosisB7-H1 AntigenPD-(L)1 Inhibitors as Monotherapy for the First-Line Treatment of Non-Small-Cell Lung Cancer Patients with High PD-L1 Expression: A Network Meta-Analysis.research article33810441open accessInmunoterapiaQuimioterapiaNeoplasiasMeta-Análisis en redCarcinoma de Pulmón de Células no PequeñasSupervivencia sin progresión10.3390/jcm10071365PMC8036854https://www.mdpi.com/2077-0383/10/7/1365/pdf?version=1617937091https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8036854/pdf