Neoadjuvant Immunotherapy Improves Treatment for Early Resectable Non-Small-Cell Lung Cancer: A Systematic Review and Meta-analysis

Abstract

Objective. Immunotherapy has shown better efficacy and less toxicity than chemotherapy in the treatment of non-small-cell lung cancer (NSCLC) at advanced stage. This study evaluates the safety and efficacy of neoadjuvant immunotherapy for resectable NSCLC. Methods. Literature examination was performed by searching the PubMed, the Cochrane Library, and Embase for articles evaluating the efficacy and safety of neoadjuvant immunotherapy for resectable NSCLC. The 95% confidence interval (CI) and effect sizes (ES) were evaluated. Heterogeneity and subgroup analysis were performed. Meta-analysis was carried out using Stata BE17 software. Results. In total, 678 patients from eighteen studies were recruited in this meta-analysis. The pathological complete response (pCR) and major pathological response (MPR) were used to evaluate the efficacy of neoadjuvant immunotherapy. Significantly higher MPR values were observed in neoadjuvant immunotherapy (MPR : ES = 0.44; 95% CI: 0.33–0.55; pCR : ES = 0.22; 95% CI: 0.15–0.30) compared with neoadjuvant chemotherapy (MPR < 25% and PCR : ES = 2%–15%). Treatment-related adverse events (TRAE), surgical resection rate, surgical delay rate, and incidence of surgical complications were used to evaluate the safety. In summary, ES values for the incidence of TRAE, incidence of surgical complications, and surgical delay rate were 0.4, 0.24, and 0.04, respectively, that were significantly lower than those for neoadjuvant chemotherapy (95% CI: 0.04–0.90; 0.22–0.75; and 0.01–0.10, respectively). The mean surgical resection rate of 89% was similar to the reported 75%–90% resection rate with neoadjuvant chemotherapy (OR = 7.61, 95% CI: 4.90–11.81). Conclusion. Neoadjuvant immunotherapy is safe and effective for resectable NSCLC.

Efficacy and safety of neoadjuvant immunotherapy protocols and cycles for non-small cell lung cancer: a systematic review and meta-analysis

“…It cannot be excluded that the differences are related to indicators such as the neoadjuvant treatment regimen, cycle, or type of immune checkpoint inhibitors (ICIs). Previous meta-analyses have confirmed that different ICIs have no significant impact on the safety and feasibility of treatment (7). Therefore, we conducted a meta-analysis of the different neoadjuvant immunotherapy regimens and cycles.…”

Neoadjuvant Immunotherapy and Non–Small Cell Lung Cancer

“…Through a previous literature search, we found that the current systematic reviews and meta-analyses [10][11][12][13][14][15][16][17] of neoadjuvant immunotherapy in NSCLC were just based on singlearm studies, or single-arm and multiarm mixed studies, but not based on RCTs. In this study, a systematic review and metaanalysis were conducted based on the RCTs (Supplemental Materials, Table S1, Supplemental Digital Content 1, http:// links.lww.com/AJCO/A493; "Preferred Reporting Items for Systematic Reviews and Meta-analyses" checklist) to evaluate the efficacy and safety of neoadjuvant immunotherapy for NSCLC, to provide more reliable clinical evidence for neoadjuvant immunotherapy of patients with NSCLC.…”