Neoadjuvant Chemoimmunotherapy for NSCLC: A Systematic Review and Meta-Analysis

Area of Science:

• Oncology
• Thoracic Surgery
• Medical Research

Background:

• No comprehensive meta-analyses have assessed neoadjuvant chemoimmunotherapy in non-small cell lung cancer (NSCLC).
• Controversy exists regarding the efficacy of neoadjuvant chemoimmunotherapy in NSCLC patients with programmed cell death 1 ligand 1 (PD-L1) levels below 1%.

Purpose of the Study:

• To compare neoadjuvant chemoimmunotherapy versus chemotherapy in NSCLC.
• To evaluate differences in adverse events, surgical, pathological, and efficacy outcomes.
• To synthesize evidence from randomized and nonrandomized clinical trials.

Main Methods:

• Systematic literature search of MEDLINE and Embase (January 2013–October 2023) for clinical trials including at least 10 patients.
• Exclusion of studies on neoadjuvant radiotherapy, chemoradiotherapy, targeted therapy, or immunotherapy monotherapy.
• Random-effects meta-analysis of pooled surgical, pathological, efficacy endpoints, and adverse events.

Main Results:

• Analysis of 43 trials with 5431 patients, including 8 randomized trials (3387 patients).
• Neoadjuvant chemoimmunotherapy demonstrated superior overall survival (HR, 0.65), event-free survival (HR, 0.59), major pathological response (RR, 3.42), and complete pathological response (RR, 5.52) in randomized trials.
• Patients with PD-L1 levels <1% showed a significant event-free survival benefit with neoadjuvant chemoimmunotherapy (HR, 0.74).

Conclusions:

• Neoadjuvant chemoimmunotherapy is superior to neoadjuvant chemotherapy across key surgical, pathological, and efficacy outcomes in NSCLC.
• Patients with resectable NSCLC and PD-L1 levels <1% may benefit from neoadjuvant chemoimmunotherapy, particularly regarding event-free survival.