Authors' results and conclusions: This review evaluated the efficacy and safety of immune checkpoint inhibitors as monotherapy in patients with previously treated advanced or metastatic non–small-cell lung cancer (NSCLC) harbouring EGFR, ALK, ROS1, or RET mutations. Thirteen systematic reviews of randomized controlled trials were assessed, revealing critical methodological flaws. All reviews focused on survival outcomes for patients with NSCLC with EGFR mutations, relying on the same set of 4 clinical trials, and largely overlooked other outcomes or patient groups. Importantly, no evidence was found regarding the efficacy and safety of immune checkpoint inhibitors in patients with ALK, ROS1, or RET mutations. The reviews generally concluded that immune checkpoint inhibitors do not significantly improve overall survival or progression-free survival compared to chemotherapy in patients with EGFR mutations. Additionally, no conclusions could be drawn about benefits based on histology or anti–programmed cell death 1 ligand 1 (PD-L1) expression levels, and safety assessments were inadequate due to a lack of evidence.

Project Status: Completed

URL for project: https://www.cda-amc.ca/overview-systematic-reviews-immune-checkpoint-inhibitors-non-small-cell-lung-cancer-egfr-alk-ros1

Year Published: 2024

URL for published report: https://www.cda-amc.ca/sites/default/files/pdf/htis/2024/RE0050-NSCLC.pdf

URL for additional information: https://www.cda-amc.ca/overview-systematic-reviews-immune-checkpoint-inhibitors-non-small-cell-lung-cancer-egfr-alk-ros1

English language abstract: An English language summary is available

Publication Type: Mini HTA

Country: Canada

Organisation Name: Canada’s Drug Agency (CDA-AMC)

Contact Address: 865 Carling Ave., Suite 600 Ottawa, ON Canada K1S 5S8

Contact Name: Shannon Nordstrom

Contact Email: shannon.nordstrom@cda-amc.ca

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