Immune checkpoint inhibitors (ICIs) have dramatically prolonged survival in non-small cell lung cancer (NSCLC) patients, but little research had focused on its impact on quality of life. The purpose of our study was to compare the quality of life (QOL) in patients with NSCLC treated with programmed cell death protein-1/programmed cell death-ligand 1 (PD-1/PD-L1) inhibitors versus chemotherapy.
We searched for randomized controlled trials utilizing the Quality of Life Questionnaire Core 30 items (QLQ-C30) and the EuroQol Five Dimensions Questionnaire-3L (EQ-5D-3L) to assess the QOL of NSCLC treated with PD-1/PD-L1 inhibitors versus chemotherapy. We collected hazard ratios (HRs) for the time from baseline to the first clinically deterioration (TTD) and Effect Size as the difference in mean change between and within treatment groups in patients reported outcomes (PROs). (PROSPERO registration number CRD42022296680).
In the five trials reported by QLQ-C30, TTD was longer in PD-1/PD-L1 inhibitors compared with control groups (HR = 0.86; 95% CI = 0.76, 0.97; P = 0.013), with similar results in terms of physical function, role function, and pain. The difference in mean change between the PD-1/PD-L1 inhibitors group and the chemotherapy group in QLQ-C30 and EQ-5D VAS was 3.64 (95% CI = 1.62, 5.66; P = 0.001) and 4.74 (95% CI = 2.65, 6.83; P = 0.001), which supported PD-1/PD-L1 inhibitors. However, there was no significant difference between the two groups in the EQ-5D Utility index (mean change = 0.03; 95% CI = -0.01, 0.07; P = 0.094). The mean change from baseline to follow-up in PD-1/PD-L1 inhibitors group was 2.57 (95% CI = 0.43, 4.71; P = 0.019) and chemotherapy group was − 1.31 (95% CI = -3.71, 1.09; P = 0.284), correspondingly. The subgroup analysis (≤ 15 w vs. > 15 w) for the mean difference between groups in QLQ-C30 favored PD-1/PD-L1 inhibitors.
In conclusion, PD-1/PD-L1 inhibitors could improve the QOL of patients with NSCLC compared to chemotherapy and reduce the unfavorable symptoms during treatment.