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Neoadjuvant Immune Checkpoint Inhibitors in Non-small Cell Lung Cancer
Chongxiang Xue1, Huijing Dong1, Ying Chen1
1Beijing University of Chinese Medicine, Beijing, China.
Abstract:
Lung cancer is the leading cause of cancer-related death worldwide. A meta-analysis was conducted to assess the benefits and risks of neoadjuvant immune checkpoint inhibitors (ICIs) in non-small cell lung cancer (NSCLC). Online databases, including PubMed, Embase, Web of Science, Cochrane Library, and clinicaltrials.gov, were retrospectively and systematically searched for eligible trials from database inception to May 2021. A total of 792 patients from 21 clinical trials were included. For surgical data, the pooled operation rate and R0 resection rate were 92% (95% CI 87-96%) and 97% (95% CI 94-99%). Additionally, neoadjuvant ICIs achieved a major pathological response (MPR) of 39% (95% CI 25-53%), including 25% (95% CI 16-36%) pathological complete response (pCR). With radiological response assessment, the pooled objective response rate (ORR) and disease control rate (DCR) were 44% (95% CI 21-68%) and 88% (95% CI 75-98%), respectively. In terms of safety, the pooled rate of any-grade and grade 3-5 treatment-related adverse effects (TRAEs) were 57% (95% CI 38-76%) and 15% (95% CI 6-28%). Eventually, the study concludes that neoadjuvant ICIs are effective and safe for patients with early-stage NSCLC. Key Words: Neoadjuvant therapy, Immune checkpoint inhibitors, Non-small cell lung cancer, Meta-analysis.
Insights
Neoadjuvant immune checkpoint inhibitors (ICIs) show significant efficacy and safety in early-stage non-small cell lung cancer (NSCLC) patients. This meta-analysis confirms their benefit in improving pathological response and surgical outcomes.
Area of Science:
- Oncology
- Immunotherapy
- Thoracic Surgery
Background:
- Non-small cell lung cancer (NSCLC) remains a leading cause of cancer mortality globally.
- Neoadjuvant therapy aims to improve surgical resection and patient outcomes in early-stage NSCLC.
- Immune checkpoint inhibitors (ICIs) represent a novel therapeutic strategy in cancer treatment.
Approach:
- A systematic meta-analysis was performed on 21 clinical trials, including 792 patients with early-stage NSCLC.
- Data were collected from major online databases (PubMed, Embase, Web of Science, Cochrane Library, clinicaltrials.gov) up to May 2021.
- Pooled analyses assessed surgical outcomes, pathological response rates (MPR, pCR), radiological response (ORR, DCR), and treatment-related adverse effects (TRAEs).
Key Points:
- High pooled operation (92%) and R0 resection (97%) rates were observed.
- Neoadjuvant ICIs demonstrated a major pathological response (MPR) in 39% and pathological complete response (pCR) in 25% of patients.
- Objective response rate (ORR) was 44%, with a disease control rate (DCR) of 88%.
- Treatment-related adverse effects (TRAEs) were manageable, with any-grade and grade 3-5 rates at 57% and 15%, respectively.
Conclusions:
- Neoadjuvant immune checkpoint inhibitors (ICIs) are effective in enhancing pathological and radiological responses in early-stage NSCLC.
- The safety profile of neoadjuvant ICIs is acceptable, with manageable treatment-related adverse effects.
- Neoadjuvant ICIs represent a promising and safe therapeutic option for patients with early-stage non-small cell lung cancer.
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