• Omar Abdel-Rahman.
• Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Lotfy Elsayed Street, 11331 Cairo, Egypt. Electronic address: omar.abdelrhman@med.asu.edu.eg.
• Crit. Rev. Oncol. Hematol. 2016 May 1; 101: 75-85.

BackgroundA meta analysis of the correlation between PD-L1 levels and outcomes of PD-1/PD-L1 inhibitors in advanced non small cell lung cancer (NSCLC) has been performed.MethodsEligible studies included those evaluating PD-1/PD-L1 inhibitors in advanced NSCLC and correlating the outcomes to PD-L1 levels.ResultsThe search strategy yielded 250 potentially relevant citations from searched databases. After preclusion of ineligible studies, 12 studies were included. Comparing PD-1/PD-L1 inhibitors to docetaxel in second line treatment, the pooled hazard ratio (HR) for progression free survival (PFS) and overall survival (OS) was 0.75 (95% CI 0.62-0.90; p=0.002) and 0.61 (95% CI 0.50-75; p=0.00001) respectively; while the pooled odds ratio (OR) for objective response rate (ORR) was 1.98 (95% CI 1.28-3.07; p=0.002) in the PD-L1>1% population. Moreover, for PD-L1>1% patients versus PD-L1<1% patients treated with PD-1/PD-L1 targeted agents, the OR of ORR was 2.18 (95% CI 1.45-3.29; p=0.0002); while for PD-L1>5% patients versus PD-L1<5% patients, it was 2.66 (95% CI 1.74-4.07; p<0.00001); and for PD-L1>10% versus PD-L1<10% patients, it was 3.38 (95% CI 2.23-5.13; p<0.00001); and for PD-L1>50% versus PD-L1<50% patients, it was 3.99 (95% CI 2.81-5.66; p<0.00001).ConclusionsThe current analysis of data indicates that the benefit from PD-1 inhibitors versus docetaxel in second line treatment of NSCLC is limited to the PD-L1>1% subpopulation. Moreover, a possible dose effect relationship between the intensity of PD-L1 staining and the potential benefit from PD-1/PD-L1 targeted agents does exist with higher intensity associated with higher ORR.Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

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