Frontline anti-PD-1/PD-L1 Versus Bevacizumab in Advanced Non-Small-Cell Lung Cancer: A Network Meta-Analysis

Aim: To review the efficacy and safety of regimens containing anti-PD-1/PD-L1 and bevacizumab for patients with advanced nonsquamous, non-small-cell lung cancer. Methods: Sixteen eligible trials were assessed. Clinical outcomes and adverse events were integrated. Subgroup analysis was conducted according to PD-L1 expression and liver metastases. Results: For the PD-L1 high population, a PD-1 inhibitor plus platinum-doublet provided significant progression-free survival (PFS) benefit versus bevacizumab. While for patients harboring PD-L1 <50%, anti-PD-1/PD-L1-containing regimens performed comparably to bevacizumab. With regard to the liver metastatic population, there existed a trend that anti-PD-1 plus chemotherapy brought about PFS benefits. Conclusion: The preference for chemoimmunotherapy lacks sufficient evidence in patients harboring PD-L1 <50%. Direct head-to-head clinical trials are warranted to identify optimal therapeutic regimens for specific patients.