PD-1/PD-L1 inhibitors plus chemotherapy versus chemotherapy alone for TKIs-resistant, EGFR-mutant, advanced non-small-cell lung cancer: a phase 3 RCTs based meta-analysis

Immunotherapy combined with chemotherapy has emerged as a potential strategy to overcome tyrosine kinase inhibitors (TKIs)-resistant for advanced non-small-cell lung cancer (NSCLC); however, the efficacy and safety of PD-1/PD-L1 inhibitors plus chemotherapy (PIC) compared to chemotherapy alone require further investigation. Phase III randomized controlled trials (RCTs) were systematically searched from 6 databases. Pooled hazard ratios (HRs) for survival outcomes and risk ratios (RRs) for responses and adverse events (AEs) were calculated. Three phase III RCTs were included in the final analysis. The PIC therapy significantly improved overall survival (OS) (HR: 0.86, 95% CI: 0.75–1.00, <i>p</i> = 0.04) and progression-free survival (PFS) (HR: 0.78, 95% CI: 0.68–0.90, <i>p</i> = 0.0005) compared to chemotherapy alone. While PIC therapy improved survival in the overall population, no significant benefit was observed for patients with brain metastases and non-sensitizing EGFR mutations. However, the incidence of immune-related AEs (irAEs) (RR: 2.02, 95% CI: 1.45–2.81, <i>p</i> &lt; 0.0001) and grade 3–5 irAEs (RR: 2.02, 95% CI: 1.03–3.98, <i>p</i> = 0.04) were increased. PIC therapy may provide a survival benefit for patients with TKIs-resistant, EGFR-mutant advanced NSCLC. Moreover, this potential benefit should be weighed against the increased risk of irAEs. PROSPERO (CRD42024615907).