Date of Award
Selective Evidence-Based Medicine Review
Master of Science in Health Sciences - Physician Assistant
Physician Assistant Studies
Laura Levy, DHSc, PA-C
Objective: The objective of this selective EBM review is to determine whether or not anti-PD-1/PD-L1 monoclonal antibodies are effective in prolonging overall survival in patients with advanced non-small cell lung cancer (NSCLC).
Study Design: A systematic review and data analysis of three randomized control trials (RCTs) published after 2010. The studies were located in English written peer reviewed journals.
Data sources: Three RCTs, which evaluated the efficacy of anti-PD-1/PD-L1 monoclonal antibodies, including nivolumab and pembrolizumab, as first and second or consecutive line therapy in patients with advanced NSCLC compared to cytotoxic agents. The studies utilized were found in EBSCO host and PubMed.
Outcomes Measured: The primary endpoint of the studies was overall survival measured by quantifying survival rates at 6, 12, or 18 months.
Results: All three RCTs (Borghaei 2015, Brahmer 2015, and Reck 2016) showed that anti PD-1 monoclonal antibodies are effective in prolonging overall survival in patients with advanced NSCLC whose tumors expressed PD-L1 (p=.002, p<.001, and p=.005 respectively). All three studies proved that immunomodulating agents caused an increase in overall survival rates compared to those treated with chemotherapeutic agents as first and second or consecutive line therapy. Additionally, median overall survival time in months was significantly longer in patients who were treated with immunomodulating agents compared to cytotoxic agents.
Conclusion: Based on the data analyzed from the studies represented throughout this systematic review, anti PD-1 monoclonal antibodies are effective in prolonging overall survival in patients with advanced NSCLC. It is unclear whether or not anti PD-L1 monoclonal antibodies are effective in prolonging overall survival in the same populations of NSCLC patients due to a lack of viable study selection found during the search process. All study conclusions were based on malignancies which expressed PD-L1 in their tumors.
Bintner, Sara, "Are Anti-PD-1/PD-L1 Monoclonal Antibodies Effective in Prolonging Overall Survival in Patients with Advanced Non-small Cell Lung Cancer?" (2019). PCOM Physician Assistant Studies Student Scholarship. 457.