CHEST Guidelines-Response_chest

Response_chest_20 (1)

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Bo Zhang and colleagues critique a meta-analysis by Khunger et al., which assessed the incidence of pneumonitis in patients with non-small cell lung cancer treated with PD-1 and PD-L1 inhibitors. Zhang and colleagues raise concerns about the meta-analysis due to the absence of randomized controlled trials that directly compare PD-1 and PD-L1 inhibitors. They point out several issues affecting the meta-analysis findings: varied dosing of treatments in single-arm trials, differing follow-up times, and the lack of bias assessments for these trials. They argue that the incidence of pneumonitis across studies was too low to have clinical significance, questioning the reliability of conclusions drawn about comparative infection risks between treatments.<br /><br />Khunger and co-authors respond by acknowledging the lack of direct randomized trials comparing PD-1 and PD-L1 inhibitors but emphasize the importance of their study as one of the first efforts to compare these treatments. They note that typical adverse event rates remain consistent across different doses in clinical trials. Risk of bias assessments was indeed conducted, utilizing tools such as the Cochrane risk of bias assessment. They argue that understanding differences in life-threatening adverse events, like pneumonitis, is crucial for guiding treatment decisions as more patients receive these treatments for advanced/metastatic diseases. Hence, despite the small incidence of pneumonitis, their findings present valuable insights that could influence clinical practice. Both parties stress the importance of rigorous and varied evidence assessments in drawing reliable clinical conclusions.

Keywords

meta-analysis

pneumonitis

non-small cell lung cancer

PD-1 inhibitors

PD-L1 inhibitors

randomized controlled trials

single-arm trials

adverse events

clinical significance

bias assessments