Eficacia y seguridad en la inmunoquimioterapia con anticuerpos monoclonales anti-PDL1 versus quimioterapia con platino en el cáncer pulmonar de células no pequeñas: revisión sistemática

Abstract

Objective: To evaluate the efficacy and safety of anti-PD-L1 monoclonal antibodies immunochemotherapy compared to platinum-based chemotherapy in patients with non-small cell lung cancer (NSCLC).

Methodology: A systematic review was performed following the PRISMA 2020 methodology. The search was carried out in PubMed, Scopus, and ProQuest databases, using DeCS/MeSH descriptors combined with Boolean operators. Open-access clinical and observational studies published in the last decade, in English or Spanish, were included. The selection process was conducted using the Rayyan software, and the methodological quality of the studies was evaluated using the ROBINS-I and RoB 2 tools to assess the risk of bias.

Results: Sixteen studies were analyzed, of which five were clinical trials. Immunotherapy treatments, such as pembrolizumab and atezolizumab, showed better objective response rates (up to 64.6%) and progression-free survival (up to 12.8 months) compared to traditional chemotherapy (4.5 months). The benefits were more significant in patients with high PD-L1 expression.

Discussion: Immunochemotherapy significantly improves clinical outcomes over conventional chemotherapy, particularly in selected subgroups. However, the toxicity profile requires careful patient evaluation.

Conclusions: Anti-PD-L1 immunochemotherapy represents a more effective therapeutic strategy with sustained benefits in advanced NSCLC. It is recommended to individualize treatment and to continue with randomized studies of higher methodological quality.