CHEST Guidelines-Single-Arm-Trials-Can-Be-Used-for-Meta-analysis-to

Single-Arm-Trials-Can-Be-Used-for-Meta-analysis-to

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The letter by Zhang and colleagues critiques a meta-analysis conducted by Khunger et al., which examined the incidence of pneumonitis in patients with non-small cell lung cancer (NSCLC) treated with PD-1 and PD-L1 inhibitors. Zhang et al. argue that the conclusions drawn by Khunger et al. are unstable and unsupported due to several methodological issues.<br /><br />Firstly, they point out that none of the included studies were randomized controlled trials directly comparing PD-1 with PD-L1 inhibitors. The studies reviewed were diverse in terms of dosages and follow-up periods, and baseline characteristics such as age and sex were not considered in comparisons.<br /><br />Moreover, Zhang et al. criticize the lack of risk of bias assessment in the single-arm trials included in the meta-analysis. They stress the necessity of incorporating such assessments, quoting established methodological tools from Slim, Deeks, and Reisch for evaluating non-randomized studies.<br /><br />Additionally, Zhang et al. highlight the low incidence of pneumonitis reported (with a maximum incidence of 4.3%), suggesting that the small number of events limits the clinical significance of the findings.<br /><br />In response, Khunger et al. acknowledge the absence of direct head-to-head randomized controlled trials comparing PD-1 and PD-L1 inhibitors. They emphasize that these agents are approved for similar patient populations and characteristics. Khunger's study offers an initial look at potential differences between the two inhibitor types, acknowledging the findings need further validation through direct comparison trials. This ensures more conclusive evidence regarding pneumonitis incidence differences between PD-1 and PD-L1 inhibitors in NSCLC patients.

Keywords

Zhang

Khunger

meta-analysis

pneumonitis

NSCLC

PD-1 inhibitors

PD-L1 inhibitors

methodological issues

risk of bias

randomized controlled trials