Full
Outline
To evaluate the effectiveness, safety and economy of pembrolizumab (PEM) for locally advanced/metastatic NSCLC.
Chinese and English databases and HTA organization websites were systematically searched. Two reviewers independently identified studies, extracted data and assessed the quality of included studies. Qualitative analysis was performed from the perspectives of efficacy, safety and economy.
Three HTA reports, six systematic reviews and 14 pharmacoeconomic studies were included. In terms of effectiveness, compared with chemotherapy (CT), PEM alone could improve the overall survival (OS) of patients of locally advanced or metastatic NSCLC with PD-L1 50%, but not that of patients with PD-L1 1%~49%. PEM+CT could improve (with statistical significance, the same below) the OS and progressive-free survival (PFS) of locally advanced or metastatic NSCLC patients (regardless of PD-L1 expression level) and metastatic non squamous NSCLC patients; it could improve the PFS of metastatic squamous NSCLC patients. Compared with NIV, PEM+CT could improve the OS and PFS of PD-L1 50% of advanced or metastatic NSCLC patients and metastatic non squamous NSCLC patients, but it did not improve the OS and PFS of metastatic squamous NSCLC patients. Compared with NIV+CT, PEM+CT could improve the OS of patients with mutation negative metastatic NSCLC. Compared with BEV, PEM+CT can improve the OS of advanced or metastatic NSCLC patients with negative mutation and nonsquamous NSCLC patients with negative mutation. In terms of safety, compared with CT, PEM could reduce grade 1~5 treatment-related side effects, grade 3~5 treatment-related side effects and serious side effects in patients with advanced or metastatic NSCLC with negative mutations. Compared with CT, the incidence of grade 1~5 treatment-related side effects, grade 3~5 treatment-related side effects and serious side effects were comparable. Compared with NIV, PEM+CT increased severe side effects. The severe side effects of PEM+CT were comparable to those of NIV+CT. In terms of economy, compared with CT, for mutation-negative locally advanced or metastatic NSCLC patients with PD-L1 1%, PEM alone is not cost-effective in China. For mutation-negative metastatic non-squamous NSCLC patients, PEM+CT is also not cost-effective in China.
PEM has favorable efficacy and safety for the first-line treatment of NSCLC, However, according to its price analyzed in the study, it is not cost-effective in China currently and further price reducing may help improve its cost-effectiveness.
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| 科 Family | 属数 Number of genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) | 属 Genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) |
|---|---|---|---|---|---|---|
| 鹅膏菌科Amanitaceae | 2 | 11 | 5.26 | 鹅膏菌属 Amanita | 10 | 4.78 |
| 小菇科 Mycenaceae | 2 | 12 | 5.74 | 丝盖伞属 Inocybe | 5 | 2.39 |
| 多孔菌科 Polyporaceae | 8 | 14 | 6.70 | 蜡蘑属 Laccaria | 5 | 2.39 |
| 红菇科 Russulaceae | 3 | 23 | 11.00 | 小皮伞属 Marasmius | 6 | 2.87 |
| 小菇属 Mycena | 11 | 5.26 | ||||
| 光柄菇属 Pluteus | 5 | 2.39 | ||||
| 红菇属 Russula | 17 | 8.13 | ||||
| 栓菌属 Trametes | 5 | 2.39 |
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