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metastatic/advanced NSCLC (mNSCLC) - 1st line (L1), pembrolizumab based treatment , meta-analysis of study results

Outcome Relative effect 95%CI LoD Trt. better when I2 k (RCT/OBS) Bayesian probability Overall ROB Publication bias Degree of certainty Endpoint importance Published MA

efficacy endpoints 00

deaths (OS) 0.72 [0.57, 0.92]< 178%6 studies (6/-)99.6 %lownot evaluable highcrucial-
deaths (OS) (extension) 0.67 [0.55, 0.82]< 168%4 studies (4/-)100.0 %some concernnot evaluable moderateimportant-
PFS (extension) 0.61 [0.38, 1.00]< 195%4 studies (4/-)97.5 %some concernnot evaluable moderateimportant-
progression or deaths (PFS) 0.68 [0.49, 0.94]< 193%6 studies (6/-)98.9 %lownot evaluable highimportant-
objective responses (ORR) 1.90 [1.19, 3.04]> 189%6 studies (6/-)99.6 %lownot evaluable highnon important-
objective responses (ORR) (extension) 2.10 [1.04, 4.21]> 191%4 studies (4/-)98.1 %some concernnot evaluable moderatenon important-

safety endpoints 00

AE (any grade) 1.52 [0.52, 4.45]< 10%2 studies (2/-)22.1 %lownot evaluable highnon important-
AE (grade 3-4) 1.01 [0.79, 1.28]< 10%2 studies (2/-)47.9 %lownot evaluable highnon important-
AE leading to death (grade 5) 1.23 [0.76, 1.97]< 10%2 studies (2/-)19.9 %lownot evaluable highnon important-
AE leading to treatment discontinuation (any grade) 2.24 [1.59, 3.15]< 10%2 studies (2/-)0.0 %lownot evaluable highnon important-
AE leading to treatment discontinuation (grade 3-4) 2.07 [1.43, 2.99]< 10%2 studies (2/-)0.0 %lownot evaluable highnon important-
STRAE (any grade) 1.76 [0.55, 5.64]< 176%2 studies (2/-)17.1 %some concernnot evaluable moderatenon important-
STRAE (grade 3-4) 2.09 [0.38, 11.45]< 183%2 studies (2/-)19.9 %some concernnot evaluable moderatenon important-
TRAE (any grade) 0.31 [0.15, 0.65]< 174%3 studies (3/-)99.9 %some concernnot evaluable moderatenon important-
TRAE (grade 3-4) 0.53 [0.22, 1.29]< 190%3 studies (3/-)91.9 %some concernnot evaluable moderatenon important-
TRAE leading to death (grade 5) 1.00 [0.56, 1.77]< 10%4 studies (4/-)50.7 %some concernnot evaluable moderatenon important-
TRAE leading to discontinuation (any grade) 0.87 [0.62, 1.21]< 10%3 studies (3/-)79.6 %some concernnot evaluable moderatenon important-
TRAE leading to discontinuation (grade 3-4) 1.09 [0.74, 1.61]< 10%3 studies (3/-)32.7 %some concernnot evaluable moderatenon important-

TRAE (grade 3-4) endpoints 00

Acute kidney injury TRAE (grade 3-4) 4.32 [0.19, 97.73]< 10%1 study (1/-)18.2 %NAnot evaluable non important-
Adrenal insufficiency TRAE (grade 3-4) 1.24 [0.16, 9.82]< 10%2 studies (2/-)41.9 %lownot evaluable highnon important-
Alopecia TRAE (grade 3-4) 0.19 [0.01, 2.53]< 117%2 studies (2/-)89.4 %some concernnot evaluable moderatenon important-
Anaemia TRAE (grade 3-4) 0.14 [0.02, 0.86]< 188%3 studies (3/-)98.3 %some concernnot evaluable moderatenon important-
Arthralgia TRAE (grade 3-4) 0.97 [0.02, 48.81]< 10%1 study (1/-)50.7 %NAnot evaluable non important-
Asthenia TRAE (grade 3-4) 0.29 [0.08, 1.05]< 10%1 study (1/-)97.0 %NAnot evaluable non important-
Blood creatinine increased TRAE (grade 3-4) 0.68 [0.05, 8.86]< 10%2 studies (2/-)61.6 %some concernnot evaluable moderatenon important-
Colitis TRAE (grade 3-4) 3.64 [0.78, 16.97]< 10%3 studies (3/-)5.0 %some concernnot evaluable moderatenon important-
Constipation TRAE (grade 3-4) 1.00 [0.10, 9.63]< 10%3 studies (3/-)50.1 %some concernnot evaluable moderatenon important-
Decreased appetite TRAE (grade 3-4) 0.47 [0.17, 1.27]< 10%3 studies (3/-)93.1 %some concernnot evaluable moderatenon important-
Diabetes TRAE (grade 3-4) 1.40 [0.13, 15.46]< 10%2 studies (2/-)39.4 %lownot evaluable highnon important-
Diarrhoea TRAE (grade 3-4) 2.81 [0.84, 9.40]< 10%3 studies (3/-)4.7 %some concernnot evaluable moderatenon important-
Dizziness TRAE (grade 3-4) 1.05 [0.02, 53.86]< 10%1 study (1/-)49.0 %NAnot evaluable non important-
Dysgeusia TRAE (grade 3-4) 1.01 [0.06, 16.31]< 10%2 studies (2/-)49.7 %some concernnot evaluable moderatenon important-
Fatigue TRAE (grade 3-4) 0.48 [0.17, 1.36]< 17%3 studies (3/-)91.6 %some concernnot evaluable moderatenon important-
Febrile neutropenia TRAE (grade 3-4) 2.12 [0.07, 64.42]< 10%1 study (1/-)33.5 %NAnot evaluable non important-
Hepatitis TRAE (grade 3-4) 7.53 [0.96, 58.84]< 10%2 studies (2/-)2.8 %some concernnot evaluable moderatenon important-
Hyperthyroidism TRAE (grade 3-4) 1.05 [0.16, 6.92]< 10%4 studies (4/-)48.0 %some concernnot evaluable moderatenon important-
Hypophysitis TRAE (grade 3-4) 2.21 [0.31, 15.58]< 10%3 studies (3/-)21.3 %some concernnot evaluable moderatenon important-
Hypothyroidism TRAE (grade 3-4) 1.50 [0.26, 8.82]< 10%4 studies (4/-)32.6 %some concernnot evaluable moderatenon important-
Increase AST TRAE (grade 3-4) 1.64 [0.38, 7.03]< 10%2 studies (2/-)25.2 %some concernnot evaluable moderatenon important-
Increased ALT TRAE (grade 3-4) 1.64 [0.59, 4.55]< 10%2 studies (2/-)17.3 %some concernnot evaluable moderatenon important-
Increased lacrimation (TRAE grade 3-4) 1.05 [0.02, 53.86]< 10%1 study (1/-)49.0 %NAnot evaluable non important-
Infusion-related reactions TRAE (grade 3-4) 0.47 [0.11, 2.06]< 10%4 studies (4/-)84.0 %some concernnot evaluable moderatenon important-
Leucopenia TRAE (grade 3-4) 0.28 [0.01, 11.52]< 164%2 studies (2/-)74.5 %some concernnot evaluable moderatenon important-
Myalgia TRAE (grade 3-4) 1.94 [0.06, 57.80]< 10%1 study (1/-)35.4 %NAnot evaluable non important-
Myocarditis TRAE (grade 3-4) 1.94 [0.06, 57.80]< 10%1 study (1/-)35.4 %NAnot evaluable non important-
Myositis TRAE (grade 3-4) 0.70 [0.04, 11.17]< 10%2 studies (2/-)60.0 %lownot evaluable highnon important-
Nausea TRAE (grade 3-4) 0.24 [0.03, 1.65]< 116%3 studies (3/-)92.5 %some concernnot evaluable moderatenon important-
Nephritis TRAE (grade 3-4) 3.10 [0.49, 19.65]< 10%3 studies (3/-)11.6 %some concernnot evaluable moderatenon important-
Neutropenia TRAE (grade 3-4) 0.10 [0.00, 2.04]< 180%3 studies (3/-)93.1 %some concernnot evaluable moderatenon important-
Pancreatitis TRAE (grade 3-4) 1.65 [0.23, 11.94]< 10%3 studies (3/-)31.1 %some concernnot evaluable moderatenon important-
Pancytopenia TRAE (grade 3-4) 0.52 [0.02, 15.84]< 10%1 study (1/-)64.4 %NAnot evaluable non important-
Peripheral neuropathy TRAE (grade 3-4) 0.10 [0.01, 1.76]< 10%1 study (1/-)94.1 %NAnot evaluable non important-
Peripheral oedema TRAE (grade 3-4) 1.05 [0.02, 53.86]< 10%1 study (1/-)49.0 %NAnot evaluable non important-
Peripheral sensory neuropathy TRAE (grade 3-4) 0.08 [0.00, 1.43]< 10%1 study (1/-)95.5 %NAnot evaluable non important-
Pneumonia TRAE (grade 3-4) 2.12 [0.07, 64.42]< 10%1 study (1/-)33.5 %NAnot evaluable non important-
Pneumonitis TRAE (grade 3-4) 3.39 [0.74, 15.55]< 155%4 studies (4/-)5.9 %some concernnot evaluable moderatenon important-
Pruritus TRAE (grade 3-4) 2.35 [0.21, 26.88]< 10%2 studies (2/-)24.7 %some concernnot evaluable moderatenon important-
Pyrexia TRAE (grade 3-4) 0.97 [0.02, 49.41]< 10%1 study (1/-)50.5 %NAnot evaluable non important-
Rash TRAE (grade 3-4) 3.75 [0.39, 35.67]< 10%2 studies (2/-)12.6 %some concernnot evaluable moderatenon important-
Sepsis TRAE (grade 3-4) 2.12 [0.07, 64.42]< 10%1 study (1/-)33.5 %NAnot evaluable non important-
Severe skin reaction TRAE (grade 3-4) 2.84 [0.68, 11.82]< 146%4 studies (4/-)7.6 %some concernnot evaluable moderatenon important-
Stomatitis TRAE (grade 3-4) 0.45 [0.06, 3.24]< 10%3 studies (3/-)78.6 %some concernnot evaluable moderatenon important-
Thrombocytopenia TRAE (grade 3-4) 0.21 [0.03, 1.28]< 148%3 studies (3/-)95.4 %some concernnot evaluable moderatenon important-
Thyroiditis TRAE (grade 3-4) 0.78 [0.08, 7.49]< 10%3 studies (3/-)58.6 %some concernnot evaluable moderatenon important-
Vomiting TRAE (grade 3-4) 0.76 [0.13, 4.47]< 10%3 studies (3/-)61.8 %some concernnot evaluable moderatenon important-

AE (grade 3-4) endpoints 00

hepatitis (Autoimmune) AE (grade 3-4) 10.24 [0.56, 188.30]< 10%1 study (1/-)6.1 %NAnot evaluable non important-
Alopecia AE (grade 3-4) 0.33 [0.03, 3.22]< 10%1 study (1/-)82.7 %NAnot evaluable non important-
Anaemia AE (grade 3-4) 0.89 [0.65, 1.20]< 10%3 studies (3/-)78.1 %lownot evaluable highnon important-
Arthralgia AE (grade 3-4) 2.02 [0.60, 6.74]< 10%2 studies (2/-)12.7 %lownot evaluable highnon important-
Asthenia AE (grade 3-4) 0.84 [0.30, 2.41]< 155%3 studies (3/-)62.4 %lownot evaluable highnon important-
Colitis AE (grade 3-4) 2.04 [0.50, 8.23]< 10%1 study (1/-)16.0 %NAnot evaluable non important-
Constipation AE (grade 3-4) 1.02 [0.33, 3.19]< 10%3 studies (3/-)48.3 %lownot evaluable highnon important-
Cough AE (grade 3-4) 0.61 [0.14, 2.65]< 10%3 studies (3/-)74.6 %lownot evaluable highnon important-
Decreased appetite AE (grade 3-4) 1.76 [0.66, 4.71]< 10%3 studies (3/-)13.2 %lownot evaluable highnon important-
Diarrhoea AE (grade 3-4) 2.25 [1.07, 4.72]< 118%3 studies (3/-)1.6 %lownot evaluable highnon important-
Dyspnoea AE (grade 3-4) 0.82 [0.44, 1.50]< 10%3 studies (3/-)74.4 %lownot evaluable highnon important-
Epistaxis AE (grade 3-4) 1.01 [0.02, 50.94]< 10%1 study (1/-)49.9 %NAnot evaluable non important-
Fatigue AE (grade 3-4) 1.38 [0.71, 2.67]< 120%3 studies (3/-)17.1 %lownot evaluable highnon important-
Hyperthyroidism AE (grade 3-4) 2.02 [0.07, 60.40]< 10%1 study (1/-)34.5 %NAnot evaluable non important-
Hypophysitis AE (grade 3-4) 4.05 [0.18, 90.23]< 10%1 study (1/-)19.1 %NAnot evaluable non important-
Hypothyroidism AE (grade 3-4) 1.32 [0.15, 11.35]< 10%2 studies (2/-)40.0 %lownot evaluable highnon important-
Infusion-related reaction AE (grade 3-4) 4.07 [0.45, 36.67]< 10%1 study (1/-)10.7 %NAnot evaluable non important-
Lacrimation increased AE (grade 3-4) 0.50 [0.01, 25.20]< 10%1 study (1/-)63.4 %NAnot evaluable non important-
Myalgia AE (grade 3-4) 2.02 [0.18, 22.43]< 10%1 study (1/-)28.5 %NAnot evaluable non important-
Nausea AE (grade 3-4) 1.01 [0.47, 2.16]< 10%3 studies (3/-)49.1 %lownot evaluable highnon important-
Neutropenia AE (grade 3-4) 1.08 [0.71, 1.66]< 146%2 studies (2/-)35.6 %lownot evaluable highnon important-
Peripheral neuropathy AE (grade 3-4) 1.52 [0.25, 9.15]< 10%1 study (1/-)32.6 %NAnot evaluable non important-
Peripheral oedema AE (grade 3-4) 1.00 [0.03, 29.86]< 10%1 study (1/-)50.1 %NAnot evaluable non important-
Pneumonitis AE (grade 3-4) 2.42 [1.05, 5.59]< 10%2 studies (2/-)2.0 %lownot evaluable highnon important-
Pyrexia AE (grade 3-4) 1.56 [0.35, 6.84]< 10%3 studies (3/-)28.0 %lownot evaluable highnon important-
Rash AE (grade 3-4) 3.20 [0.26, 39.60]< 163%2 studies (2/-)18.4 %lownot evaluable highnon important-
Severe skin reactions AE (grade 3-4) 3.04 [0.31, 29.44]< 10%1 study (1/-)17.0 %NAnot evaluable non important-
Thrombocytopenia AE (grade 3-4) 1.11 [0.70, 1.77]< 10%2 studies (2/-)33.0 %lownot evaluable highnon important-
Thyroiditis AE (grade 3-4) 2.02 [0.07, 60.40]< 10%1 study (1/-)34.5 %NAnot evaluable non important-
Vomiting AE (grade 3-4) 0.99 [0.22, 4.33]< 155%3 studies (3/-)50.8 %lownot evaluable highnon important-

LoD: level of statistical demonstration: Statistically conclusive: statistically significant with a strict control of overall risk of type 1 error (statistically demonstrated), does not take into account the risk of bias; suggested: nominally statistically significant but without a strict control of overall risk of type 1 error; inconclusive: not nominally statistically significant; safety concerns;
Bayesian probability: Bayesian posterior probability of treatment effect (computed with a noninformative prior); ROB: risk of bias; k: number of studies; published MA: number of published meta-analysis on the same topic; degree of certainty adapted from GRADE. Trt. better when: indicates when the relative treatment effect shows that the studied treatment is better than control.