SynthesisFrontiers in oncology2026
Efficacy of first-line immune checkpoint inhibitors in advanced non-small-cell lung cancer with or without brain metastases: a systematic review and network meta-analysis.
Synthesis in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
2 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Association between prognostic nutritional index and prognosis in non-small cell lung cancer patients receiving PD-1/PD-L1 inhibitors: a meta-analysis.Frontiers in nutrition · 2026Pooled it
- Course of Step Counts During Systemic Treatment for Non-small Cell Lung Cancer-Observational Data from a Prematurely Terminated Prospective Study.In vivo (Athens, Greece)Article
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Authors and funding
8 authors.
Funding
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Abstract
Background: Immune checkpoint inhibitors (ICIs) are the standard first-line care for advanced non-small cell lung cancer (NSCLC). However, optimal therapeutic choices for patients with brain metastases remain unclear due to a lack of direct comparisons. We conducted a systematic review and Bayesian network meta-analysis to evaluate the comparative efficacy of first-line ICI regimens stratified by brain metastasis status. Methods: We searched PubMed, Cochrane Library, Embase, and Web of Science for randomized controlled trials (RCTs) of first-line ICI regimens in advanced NSCLC. We performed a Bayesian network meta-analysis to estimate hazard ratios (HRs) and 95% credible intervals (CrIs) for overall survival (OS) and progression-free survival (PFS). Models were stratified by brain metastasis status to rank treatment efficacy using the CINeMA system for quality assessment. The protocol is registered with PROSPERO (CRD420251236228). Results: We synthesized data from 12 RCTs (n=7, 122) evaluating 14 ICI regimens. In patients with brain metastases, ICI plus chemotherapy significantly improved OS versus chemotherapy alone (HR = 0.57; 95% CrI: 0.45-0.72), while both monotherapy (HR = 0.50; 95% CrI: 0.30-0.85) and combination therapy (HR = 0.42; 95% CrI: 0.31-0.55) prolonged PFS. For patients without brain metastases, both strategies yielded superior OS and PFS. Bayesian ranking indicated that for brain metastases, cemiplimab plus chemotherapy conferred the greatest OS benefit (HR = 0.29; 95% CrI: 0.11-0.76; rank 1 probability: 41.66%). Regarding PFS in this subgroup, sugemalimab plus chemotherapy showed the strongest relative effect (HR = 0.30; 95% CrI: 0.15-0.59), whereas camrelizumab plus chemotherapy achieved the highest probability of ranking first (35.85%). In the non-brain metastasis cohort, pembrolizumab plus chemotherapy (HR = 0.58; 95% CrI: 0.46-0.73) and sintilimab plus chemotherapy (HR = 0.49; 95% CrI: 0.37-0.64) were the leading regimens for OS and PFS, respectively. Conclusions: ICI plus chemotherapy provides a survival advantage over chemotherapy alone in advanced NSCLC, irrespective of brain metastasis status. Bayesian rankings favor cemiplimab, sugemalimab, or camrelizumab plus chemotherapy for patients with brain metastases, and pembrolizumab or sintilimab plus chemotherapy for those without. These findings, currently limited by low-certainty indirect evidence, warrant validation in adequately powered, head-to-head trials. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD420251236228.
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