The effects of immunotherapy on prognosis for stages I to II | Figure 1

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The effects of immunotherapy on prognosis for stages I to III non‐small cell lung cancer

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Review question

Do treatments that help the body's immune system fight cancer cells (immunotherapy) make people with non‐small cell lung cancer (NSCLC) who have had surgery or radiotherapy aimed at a cure, live longer?

Background

Many people with NSCLC, who have had surgery or radiotherapy to cure their cancer, eventually die because the cancer comes back, either in the chest, or somewhere else in the body. There have been a number of trials over the years that have looked at whether immunotherapy helps people live longer. Some seemed to show a benefit, others did not.

Study characteristics

We searched four computerised databases and five trial registers to 19 May 2021. We looked for all trials that randomly allocated participants to one treatment or another (randomised controlled trials, RCTs), and included adults (aged 18 years or older) with early NSCLC (stages I to III), confirmed by laboratory testing of a sample of the tumour. We found 11 RCTs, which included over 5000 participants who had received surgery or curative radiotherapy, and were randomly allocated to receive either immunotherapy or no further treatment.

Key results

We found that giving immunotherapy, mainly vaccine‐based (aiming to activate the host immune system to induce human immune response to tumour‐specific antigens), after surgery or radiotherapy did not make people live longer. People who were given vaccine‐based immunotherapy did not seem to experience more side effects than the others. We did not find results that could tell us whether the addition of immunotherapy improved quality of life. At the moment, there is no evidence to support or refute giving immunotherapy (mainly vaccine‐based) to people with localised NSCLC (stages I to III). RCTs in progress are testing new, more promising immunotherapy drugs (e.g. checkpoint inhibitors).

Quality of the evidence

The evidence we found about overall survival and progression‐free survival was of high and moderate quality, respectively. When we looked for evidence about how many participants lived to one, two, three, or five years, it was only moderate or low quality, because the RCTs were not very well done, and their results did not agree with each other. The evidence for both any and severe adverse events was of low quality.

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