Introduction Despite comprising many cancer diagnoses, few treatments are suitable for patients with advanced non-small cell lung cancer (aNSCLC). Trials suggest blockade of programmed death 1 (PD1) or its ligand (PDL1) may be effective for these patients. However, this therapy’s impact on outcomes other than survival, and outcomes of patients not in trials, remains largely unknown. Therefore, we compared the effectiveness of PD1 and PDL1 immunotherapy to chemotherapy and placebo across multiple clinical outcomes. Methods Six databases were searched on 12–13 October 2019 for randomised controlled trials (RCTs) and observational studies investigating nivolumab, pembrolizumab, atezolizumab or durvalumab. Study selection was performed independently by two reviewers. Data for overall survival, progression-free survival, adverse effects (AEs) and quality of life (QoL) were descriptively and meta-analysed. Factors impacting treatment outcomes, including PDL1 expression, were explored. The similarity between RCT and observational data was assessed. Results From 5423 search results, 139 full texts and abstracts were included. Immunotherapy was associated with a lower risk of death than both comparators. In RCTs, the incidence of treatment-related AEs was approximately 20% lower among patients using immunotherapy compared with chemotherapy. However, no other consistent benefits were observed. Progression-free survival results were inconsistent. Improvements to QoL varied according to the instrument used; however, QoL was not recorded widely. Survival results were similar between study designs; however, AEs incidence was lower in observational studies. Discussion Among patients with aNSCLC, immunotherapy improved overall survival and incidence of treatment-related AEs compared with chemotherapy. Benefits to progression-free survival and QoL were less consistent. PROSPERO registration number CRD42019153345. Data are available upon reasonable request. Given the large number of studies included in this review, not all data gathered could be included in the article. However, we have kept a database of all data collected pertaining to this review, which can be made available upon request.

中文翻译：

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PD1 和 PDL1 免疫疗法对非小细胞肺癌预后的影响：系统评价

简介 尽管包括许多癌症诊断，但很少有治疗方法适用于晚期非小细胞肺癌 (aNSCLC) 患者。试验表明，程序性死亡 1 (PD1) 或其配体 (PDL1) 的阻断可能对这些患者有效。然而，这种疗法对生存以外的结果以及未参加试验的患者的结果的影响在很大程度上仍然未知。因此，我们在多个临床结果中比较了 PD1 和 PDL1 免疫疗法与化疗和安慰剂的有效性。方法 于 2019 年 10 月 12 日至 13 日在六个数据库中搜索了随机对照试验 (RCT) 和观察性研究，调查了 nivolumab、pembrolizumab、atezolizumab 或 durvalumab。研究选择由两名评价者独立进行。总生存期、无进展生存期的数据，对不良反应 (AE) 和生活质量 (QoL) 进行了描述性和荟萃分析。探讨了影响治疗结果的因素，包括 PDL1 表达。评估了 RCT 和观察数据之间的相似性。结果 从 5423 个搜索结果中，包括 139 个全文和摘要。与两种比较药物相比，免疫疗法与较低的死亡风险相关。在随机对照试验中，与化疗相比，使用免疫疗法的患者治疗相关 AE 的发生率大约低 20%。但是，没有观察到其他一致的好处。无进展生存期结果不一致。QoL 的改善因使用的仪器而异；然而，QoL 并未得到广泛记录。不同研究设计的生存结果相似；然而，观察性研究中的 AE 发生率较低。讨论 在 aNSCLC 患者中，与化疗相比，免疫疗法改善了总生存期和治疗相关 AE 的发生率。对无进展生存期和 QoL 的益处不太一致。PROSPERO 注册号 CRD42019153345。可根据合理要求提供数据。鉴于本综述中包含大量研究，并非所有收集的数据都可以包含在文章中。但是，我们保留了一个数据库，其中包含与本次审查有关的所有收集数据，可应要求提供。鉴于本综述中包含大量研究，并非所有收集的数据都可以包含在文章中。但是，我们保留了一个数据库，其中包含与本次审查有关的所有收集数据，可应要求提供。鉴于本综述中包含大量研究，并非所有收集的数据都可以包含在文章中。但是，我们保留了一个数据库，其中包含与本次审查有关的所有收集数据，可应要求提供。