Efficacy of Adding Immune Checkpoint Inhibition to Chemotherapy, With or Without VEGF Inhibition, in Patients With Advanced EGFR-Mutated NSCLC: A Systematic Review and Meta-Analysis With Reconstructed Individual Patient Data

作者：Alessandro Di Federico, Sara Stumpo, Linda Danielli, Giacomo Corradi, Biagio Ricciuti, Federica Pecci, Joao V. Alessi, Xinan Wang, Andrea De Giglio, Francesca Lo Bianco, Francesco Mantuano, Maria A. Pantaleo, Francesca Sperandi, Barbara Melotti, Francesco Gelsomino, Andrea Ardizzoni · 发表于：JTO Clinical and Research Reports · 年份：2026 · DOI：10.1016/j.jtocrr.2026.100961 · 研究领域：Cancer Immunotherapy and Biomarkers、Lung Cancer Treatments and Mutations、Lung Cancer Diagnosis and Treatment

Whether adding immunotherapy to chemotherapy is beneficial for some patients with EGFR -mutated non-small cell lung cancer (NSCLC), and whether concomitant vascular endothelial growth factor inhibition (VEGFi) further enhances this strategy, are still subjects of debate. We performed a systematic review and meta-analysis with reconstructed individual patient data to assess outcomes to chemo-immunotherapy +/- VEGFi in patients with advanced EGFR -mutated NSCLC after failure of EGFR-tyrosine kinase inhibitors. Among seven RCTs (n= 2,196 patients), compared to chemotherapy +/- VEGFi, chemo-immunotherapy extended the median progression-free survival (mPFS) whether combined with VEGFi (8.1 versus 5.5 months; HR 0.59; 95%CI, 0.53–0.67; p<0.0001) or not (5.6 versus 5.5 months; HR 0.83, 95%CI, 0.74-0.93; p=0.0017). Adding VEGFi to chemo-immunotherapy prolonged the mPFS even compared with chemo-immunotherapy alone (HR 0.72; 95%CI, 0.63–0.82; p<0.0001). Similarly, median overall survival (mOS) was extended by chemo-immunotherapy with VEGFi (19.0 versus 15.7 months; HR 0.77; 95%CI, 0.67–0.89; p=0.00046) and without VEGFi (18.1 versus 15.7 months; HR 0.86, 95%CI, 0.76-0.97; p=0.018) compared to chemotherapy +/- VEGFi. However, adding VEGFi to chemo-immunotherapy did not extend the mOS compared with chemo-immunotherapy alone (HR 0.90, 95%CI, 0.77-1.05, p=0.18). These results were consistent in trial-level HR meta-analyses, where chemo-immunotherapy, only when combined with VEGFi, also imp...