Câncer de pulmão de células não pequenas: uma análise comparativa entre imunoterapia e tratamentos convencionais
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Jul 22, 2025
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Resumo
Objetivo: Analisar a eficácia e a segurança de imunoterápicos isolados ou em combinação com outras terapias, em comparação com tratamentos tradicionais para pacientes com câncer de pulmão de células não pequenas (CPCNP) em vários estágios e linhas de tratamento. Métodos: Revisão integrativa, nas bases de dados National Library of Medicine and National Institutes of Health (PubMed) e Biblioteca Virtual em Saúde (bvs). A busca foi realizada em abril de 2025. Os descritores DeCS foram câncer de pulmão, câncer de células não pequenas e imunoterapia, e seus correspondentes em inglês com o operador booleano “AND”. Os critérios de inclusão foram: publicações dos últimos 5 anos, de livre acesso, disponibilizadas na íntegra em português, inglês e espanhol. Foi utilizado o Rayyan para seleção dos artigos de maneira imparcial. Resultados: Este estudo analisou 30 artigos comparando imunoterapia, associado ou não a tratamentos convencionais ou terapias isoladas. Os resultados obtidos foram apresentados nos quadros 1 e 2, os quais apresentam os autores e principais achados. Considerações finais: Diante dos resultados analisados, concluiu-se que a escolha do imunoterápico deve considerar a histologia, o PD-L1 e os efeitos adversos associados. De forma geral, as combinações com quimioterapia são mais benéficas em comparação à utilização isolada do imunoterápico.
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Como Citar
RabeloJ. C. S., RosaA. S. B. de O., CostaF. de S. da, GaiaG. L., SantanaM. F., & DantasR. A. E. (2025). Câncer de pulmão de células não pequenas: uma análise comparativa entre imunoterapia e tratamentos convencionais. Revista Eletrônica Acervo Médico, 25, e21128. https://doi.org/10.25248/reamed.e21128.2025
Seção
Revisão Bibliográfica
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Referências
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24. WANG C, et al. Neoadjuvant nivolumab plus chemotherapy versus chemotherapy for resectable NSCLC: subpopulation analysis of Chinese patients in CheckMate 816. ESMO Open, 2023; 8(6):102040.
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26. WEST HJ, et al. Clinical efficacy of atezolizumab plus bevacizumab and chemotherapy in KRAS-mutated non-small cell lung cancer with STK11, KEAP1, or TP53 comutations: subgroup results from the phase III IMpower150 trial. J Immunother Cancer, 2022; 10(2):e003027.
27. ZHOU C, et al. Camrelizumab plus carboplatin and pemetrexed as first-line treatment for advanced nonsquamous NSCLC: Extended follow-up of CameL phase 3 trial. J Thorac Oncol, 2023; 18(5):628–39.
28. ZHOU C, et al. Camrelizumab plus carboplatin and pemetrexed as first-line therapy for advanced non-squamous non-small-cell lung cancer: 5-year outcomes of the CameL randomized phase 3 study. J Immunother Cancer, 2024; 12(11).
29. ZHOU C, et al. A global phase 3 study of serplulimab plus chemotherapy as first-line treatment for advanced squamous non-small-cell lung cancer (ASTRUM-004). Cancer Cell, 2024; 12; 42(2):198-208.e3.
30. ZHOU H-Q, et al. Gefitinib (an EGFR tyrosine kinase inhibitor) plus anlotinib (an multikinase inhibitor) for untreated, EGFR-mutated, advanced non-small cell lung cancer (FL-ALTER): a multicenter phase III trial. Signal Transduct Target Ther, 2024; 9(1):215.
2. BARAMIDZE A, et al. Cemiplimab plus chemotherapy versus chemotherapy alone in non-small cell lung cancer with PD-L1 ≥ 1 %: A subgroup analysis from the EMPOWER-Lung 3 part 2 trial. Lung Cancer, 2024; 193(107821):107821.
3. BORGHAEI H, et al. Nivolumab plus chemotherapy in first-line metastatic non-small-cell lung cancer: results of the phase III CheckMate 227 Part 2 trial. ESMO Open, 2023; 8(6):102065.
4. BORGHAEI H, et al. SAPPHIRE: phase III study of sitravatinib plus nivolumab versus docetaxel in advanced nonsquamous non-small-cell lung cancer. Ann Oncol, 2024; 35(1):66-76.
5. CARBONE DP, et al. Four-year clinical update and treatment switching-adjusted outcomes with first-line nivolumab plus ipilimumab with chemotherapy for metastatic non-small cell lung cancer in the CheckMate 9LA randomized trial. J Immunother Cancer, 2024; 12, 12(2): e008189.
6. DAMONTE A, et al. Resultados quirúrgicos post neoadyuvancia con inmunoterapia en cáncer de pulmón: CheckMate 816 en subpoblación Argentina. Medicina (B Aires), 2025;85(1):47–55.
7. FORDE PM, et al. Neoadjuvant nivolumab plus chemotherapy in resectable lung cancer. N Engl J Med, 2022; 386 (21): 1973–85.
8. GARON EB, et al. Patient-reported outcomes with durvalumab, with or without tremelimumab, plus chemotherapy as first-line treatment for metastatic non-small-cell lung cancer (POSEIDON). Lung Cancer, 2024;186(107422):107422.
9. GETTINGER SN, et al. Nivolumab plus ipilimumab vs nivolumab for previously treated patients with stage IV squamous cell lung cancer: The lung-MAP S1400I phase 3 randomized clinical trial: The lung-MAP S1400I phase 3 randomized clinical trial. JAMA Oncol [Internet]. 2021;7(9):1368–77.
10. JOHN T, et al. First-line nivolumab plus ipilimumab combined with two cycles of chemotherapy in advanced non-small cell lung cancer: a subanalysis of Asian patients in CheckMate 9LA. Int J Clin Oncol, 2022; 27(4):695–706.
11. LU S, et al. Nivolumab versus docetaxel in a predominantly Chinese patient population with previously treated advanced non-small cell lung cancer: 2-year follow-up from a randomized, open-label, phase 3 study (CheckMate 078). Lung Cancer, 2021; 152:7–14.
12. MAKHARADZE T, et al. Cemiplimab plus chemotherapy versus chemotherapy alone in advanced NSCLC: 2-year follow-up from the phase 3 EMPOWER-Lung 3 part 2 trial. J Thorac Oncol, 2023; 18(6):755–68.
13. NEAL J, et al. CONTACT-01: A randomized phase III trial of atezolizumab + cabozantinib versus docetaxel for metastatic non-small cell lung cancer after a checkpoint inhibitor and chemotherapy. J Clin Oncol, 2024; 42(20):2393–403.
14. PARK K, et al. Avelumab versus docetaxel in patients with platinum-treated advanced NSCLC: 2-year follow-up from the JAVELIN Lung 200 phase 3 trial. J Thorac Oncol, 2021; 16(8):1369–78.
15. PASSARO A, et al. Amivantamab plus chemotherapy with and without lazertinib in EGFR-mutant advanced NSCLC after disease progression on osimertinib: primary results from the phase III MARIPOSA-2 study. Ann Oncol, 2024; 35 (1): 77–90.
16. PETERS S, et al. Atezolizumab versus chemotherapy in advanced or metastatic NSCLC with high blood-based tumor mutational burden: primary analysis of BFAST cohort C randomized phase 3 trial. Nat med, 2022; 28(9):1831–9.
17. PETERS S, et al. Long-term survival outcomes with first-line nivolumab plus ipilimumab-based treatment in patients with metastatic NSCLC and tumor programmed death-ligand 1 lower than 1%: A pooled analysis. J Thorac Oncol, 2025; 20(1):94–108.
18. PROVENCIO M, et al. Perioperative chemotherapy and nivolumab in non-small-cell lung cancer (NADIM): 5-year clinical outcomes from a multicentre, single-arm, phase 2 trial. Lancet Oncol, 2024; 25(11):1453-1464. Erratum in: Lancet Oncol. 2024; 25(11):e542.
19. RECK M, et al. Five-year outcomes with pembrolizumab versus chemotherapy for metastatic non-small-cell lung cancer with PD-L1 tumor proportion score ≥ 50. J Clin Oncol, 2021;39(21):2339–49.
20. RECK M, et al. Safety and patient-reported outcomes of atezolizumab plus chemotherapy with or without bevacizumab versus bevacizumab plus chemotherapy in non-small-cell Lung Cancer. J Clin Oncol, 2020; 38(22):2530–42.
21. SENAN S, et al. Outcomes with durvalumab after chemoradiotherapy in stage IIIA-N2 non-small-cell lung cancer: an exploratory analysis from the PACIFIC trial. ESMO Open, 2022; 7(2):100410.
22. SHI Y, et al. Sintilimab versus docetaxel as second-line treatment in advanced or metastatic squamous non-small-cell lung cancer: an open-label, randomized controlled phase 3 trial (ORIENT-3). Cancer Commun, 2022; 42(12):1314–30.
23. SUGAWARA S, et al. Pembrolizumab plus chemotherapy in Japanese patients with metastatic squamous non-small-cell lung cancer in KEYNOTE-407. Cancer Sci, 2023;114(8):3330–41.
24. WANG C, et al. Neoadjuvant nivolumab plus chemotherapy versus chemotherapy for resectable NSCLC: subpopulation analysis of Chinese patients in CheckMate 816. ESMO Open, 2023; 8(6):102040.
25. WANG J, et al. Tislelizumab plus chemotherapy versus chemotherapy alone as first-line treatment for advanced squamous non-small-cell lung cancer: final analysis of the randomized, phase III RATIONALE-307 trial. ESMO Open, 2024; 9(10):103727.
26. WEST HJ, et al. Clinical efficacy of atezolizumab plus bevacizumab and chemotherapy in KRAS-mutated non-small cell lung cancer with STK11, KEAP1, or TP53 comutations: subgroup results from the phase III IMpower150 trial. J Immunother Cancer, 2022; 10(2):e003027.
27. ZHOU C, et al. Camrelizumab plus carboplatin and pemetrexed as first-line treatment for advanced nonsquamous NSCLC: Extended follow-up of CameL phase 3 trial. J Thorac Oncol, 2023; 18(5):628–39.
28. ZHOU C, et al. Camrelizumab plus carboplatin and pemetrexed as first-line therapy for advanced non-squamous non-small-cell lung cancer: 5-year outcomes of the CameL randomized phase 3 study. J Immunother Cancer, 2024; 12(11).
29. ZHOU C, et al. A global phase 3 study of serplulimab plus chemotherapy as first-line treatment for advanced squamous non-small-cell lung cancer (ASTRUM-004). Cancer Cell, 2024; 12; 42(2):198-208.e3.
30. ZHOU H-Q, et al. Gefitinib (an EGFR tyrosine kinase inhibitor) plus anlotinib (an multikinase inhibitor) for untreated, EGFR-mutated, advanced non-small cell lung cancer (FL-ALTER): a multicenter phase III trial. Signal Transduct Target Ther, 2024; 9(1):215.