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Incidence risk of PD-1/PD-L1 related diarrhea in non-small cell lung cancer (NSCLC) patients: a systematic review and meta-analysis

Authors Zhang C, Zhang S, Xu D, Liu R, Zhu Q, Zhao Y, Mao Y, Tian Y

Received 24 January 2019

Accepted for publication 10 April 2019

Published 2 May 2019 Volume 2019:11 Pages 3957—3969


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Antonella D'Anneo

Caiqing Zhang,1 Shuisheng Zhang,2 Deguo Xu,3 Rujun Liu,4 Qingshan Zhu,5 Yi Zhao,6 Yantao Mao,7 Yuan Tian3

1Department of Respiratory, Shandong Provincial Qianfoshan Hospital Affiliated to Shandong University, Jinan, Shandong 250014, People’s Republic of China; 2Department of General Surgery, Peking University Third Hospital, Beijing 100191, People’s Republic of China; 3Department of Radiotherapy Oncology, Shandong Provincial Qianfoshan Hospital Affiliated to Shandong University, Jinan, Shandong 250014, People’s Republic of China; 4Department of Oncology, LongKou People,,s Hospital, Yantai, Shandong 265701, People’s Republic of China; 5Department of Radiotherapy oncology, Anyang Cancer Hospital of Henan Province, Anyang, Henan 455000, People’s Republic of China; 6Department of Oncology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, People’s Republic of China; 7Department of Oncology, Yantaishan Hospital of Shandong Province, Yantai, 264000, People’s Republic of China

Purpose: We designed the study to illustrate the OR of programmed cell death-1 (PD-1) or ligand 1 (PD-L1) inhibitor-related diarrhea in patients with non-small cell lung cancer.
Method: This systematic review and meta-analysis were put into practice according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Incidence of all grades for PD-1/PD-L1 inhibitor-related diarrhea in NSCLC was taken into account.
Results: After screening and eligibility assessment of 57 articles, a total of 12 clinical trials involving 6,659 participants were collected for the final meta-analysis. The incidence risk of diarrhea for all grades was lower in PD-1 inhibitor monotherapy compared to monochemotherapy of docetaxel (OR=0.31, 95% CI [0.24, 0.41]; I2,=0%, Z=8.23 (p<0.00001)), while a similar result could also be seen in PD-L1 inhibitor monotherapy group (OR=0.41, 95% CI [0.27, 0.64]; I2,=59%, Z=3.92 [p<0.00001]). The opposite result can be seen when PD-1/PD-L1 inhibitor combined chemotherapy was compared to chemotherapy alone (OR=1.51, 95% CI [1.22, 1.87]; I2,=0%, Z=3.77 [p<0.00001]). Similar incidence trend could also be seen in the meta-analysis of diarrhea for grade 1–2 and grade 3–5.
Conclusion: The incidence risk of diarrhea associated with PD-1/-PD-L1 inhibitor monotherapy was significantly lower than that of docetaxel monotherapy group. However it was higher in PD-1/PD-L1 inhibitor combined with chemotherapy group compared with the chemotherapy alone group.

Keywords: diarrhea, PD-1/PD-L1, NSCLC, meta-analysis

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