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Lung Cancer Research Studies / Lung Cancer Treatments and Mutations · Journal article
BMC Medicine · August 14, 2026
Well-designed and adequately powered for the question it asks.
This meta-analysis of 13 randomized trials demonstrates that first-line ICI-based therapies, particularly immunochemotherapy, significantly delay health-related quality-of-life deterioration compared with chemotherapy in advanced NSCLC. The effect is robust (HR 0.75 for global QoL, 95% CI 0.71–0.81) with negligible heterogeneity, supporting more durable preservation of patient-reported outcomes alongside established survival benefits.
Systematic review and meta-analysis of randomized controlled trials. 6555 aNSCLC patients from 13 randomized trials comparing ICI-based therapies with chemotherapy as first-line treatment.. Intervention: First-line ICI-based therapies: ICI monotherapy, dual ICI combinations, or ICIs combined with chemotherapy.. Compared with: First-line chemotherapy. n = 6,555.
ICI-based therapies delayed global QoL deterioration versus chemotherapy (HR 0.75, 95% CI 0.71–0.81; p<0.0001, I2=0%) Immunochemotherapy showed benefit in TTD of global QoL (HR 0.74, 95% CI 0.69–0.80; I2=0%), whereas ICI monotherapy did not reach significance (HR 0.78, 95% CI 0.58–1.05; I2=0%) ICI-based therapies delayed deterioration in fatigue, pain, cough, dyspnea, and composite cough/chest pain/dyspnea endpoint, but not appetite loss
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Clinicians should recognize that beyond survival benefits, first-line ICI-based therapies—especially when combined with chemotherapy—better preserve patients' health-related quality of life trajectories compared with chemotherapy. This finding supports patient-centered decision-making and reinforces the role of ICI-based regimens in first-line aNSCLC treatment.
Rigorous systematic review and meta-analysis of 13 phase II–III RCTs with 6555 patients showing that ICI-based therapies significantly delay QoL deterioration versus chemotherapy, with low heterogeneity and prespecified outcomes, but surrogate endpoints rather than hard clinical outcomes.
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Clinicians should recognize that beyond survival benefits, first-line ICI-based therapies—especially when combined with chemotherapy—better preserve patients' health-related quality of life trajectories compared with chemotherapy. This finding supports patient-centered decision-making and reinforces the role of ICI-based regimens in first-line aNSCLC treatment.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Backgroud: Immune checkpoint inhibitors (ICIs) have transformed first-line treatment for advanced non–small-cell lung cancer (aNSCLC). While overall survival(OS) remains the primary endpoint, health-related quality of life (HRQoL) is a key patient-centered outcome. Time to deterioration (TTD) captures the durability of HRQoL over treatment. This study compared TTD in HRQoL between patients receiving ICI-based therapies and chemotherapy, and conducted exploratory analyses to assess the association between trial-level hazard ratios(HRs) for TTD and OS.Method: MEDLINE, CENTRAL, and Scopus were systematically searched from inception to September 2025. Eligible studies included phase II or III randomized clinical trials evaluating first-line ICIs–based therapies(ICI monotherapy, dual ICI combinations, or ICIs combined with chemotherapy) for aNSCLC and reporting TTD in HRQoL.The prespecified primary outcome was hazard ratio (HR) for TTD of global QoL between aNSCLC patients treated with ICI–based therapies and those receiving chemotherapy. Secondary outcomes were HR for TTD of physical and emotional functioning and symptomatology. (PROSPERO registration number: CRD420251266405).Result: A total of 6555 aNSCLC patients from 13 randomized trials comparing ICI-based therapies with chemotherapy were included. Compared with chemotherapy, ICIs–based therapies delayed deterioration of global QoL (HR 0.75, 95% confidence interval [CI] 0.71–0.81; p<0.0001, I2=0%). Regimen-specific analyses indicated that Immunochemotherapy delayed TTD in Global QoL over chemotherapy(HR 0.74, 95%CI 0.69-0.80; I2=0%), whereas no significant benefit in TTD of Global QoL was observed with immunotherapy(HR 0.78, 95%CI 0.58-1.05; I2=0%), with similar patterns for physical functioning. Across symptom outcomes, ICI based therapies delayed deterioration in several symptoms, including fatigue, pain, cough, dyspnea, and the composite endpoint of cough, chest pain, or dyspnea, while no significant difference was observed for appetite loss. Exploratory analyses further suggested an association between trial-level HRs for TTD of HRQoL and HRs for OS, although these findings should be interpreted cautiously.Conclusion: Among patients with aNSCLC, first-line ICI-based therapies significantly delayed deterioration of HRQoL compared with chemotherapy. These findings indicate that ICI-based therapies—particularly immunochemotherapy—are associated with more durable preservation of HRQoL in first-line treatment, complementing their established survival benefits. Exploratory analyses further suggested that trial-level HRs for HRQoL deterioration were positively associated with HR for OS.
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