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Published on: September 25, 2018
Perioperative PD-1/PD-L1 inhibitors for resectable non-small cell lung cancer: A meta-analysis based on randomized
Hai Huang1, Lianyun Li1, Ling Tong1
1Department of Oncology, Taihe People's Hospital, Taihe, China.
Background:
PD-1/PD-L1 inhibitors (PI) have shown promising results in both neoadjuvant and adjuvant therapies for resectable non-small cell lung cancer (NSCLC). However, substantial evidence from large-scale studies is still lacking for their use in the perioperative setting (neoadjuvant plus adjuvant). This meta-analysis aims to evaluate the integration of perioperative PI (PPI) with neoadjuvant chemotherapy for resectable NSCLC.
Methods:
To identify appropriate randomized controlled trials (RCTs), we thoroughly explored six different databases. The primary endpoint was survival, while the secondary measures included pathological responses and adverse events (AEs).
Results:
Six RCTs involving 2941 patients were included. The PPI group significantly improved overall survival (OS) (hazard ratio [HR]: 0.62 [0.51, 0.77]), event-free survival (EFS) (HR: 0.57 [0.51, 0.64]), pathological complete response (risk ratio [RR]: 5.81 [4.47, 7.57]), and major pathological response (RR: 2.60 [1.77, 3.82]). Benefits in EFS were seen across all subgroups. OS rates at 12-48 months and EFS rates at 6-48 months were higher in the PPI cohort. Furthermore, the advantages in OS and EFS increased with prolonged survival times. The PPI group also exhibited higher rates of surgery and R0 resections. However, the PPI group experienced more grade 3-5 AEs, serious AEs, and treatment discontinuations due to AEs.
Conclusions:
The integration of perioperative PI with neoadjuvant chemotherapy can significantly improve survival and pathological responses for resectable NSCLC. However, the increased incidence of grade 3-5 AEs must be carefully evaluated.
Insights
Perioperative PD-1/PD-L1 inhibitors combined with chemotherapy improve survival and pathological responses in resectable non-small cell lung cancer. Increased adverse events require careful consideration.
Area of Science:
- Oncology
- Medical Research
Background:
- PD-1/PD-L1 inhibitors show promise in neoadjuvant/adjuvant therapy for resectable non-small cell lung cancer (NSCLC).
- Limited large-scale evidence exists for perioperative use (neoadjuvant + adjuvant).
Purpose of the Study:
- To evaluate the efficacy and safety of integrating perioperative PD-1/PD-L1 inhibitors (PPI) with neoadjuvant chemotherapy for resectable NSCLC.
Main Methods:
- Systematic review and meta-analysis of six randomized controlled trials (RCTs).
- Involved 2941 patients.
- Primary endpoint: survival; Secondary endpoints: pathological responses and adverse events.
Main Results:
- Perioperative PI significantly improved overall survival (OS) and event-free survival (EFS).
- Pathological complete response and major pathological response rates were notably higher.
- Increased rates of grade 3-5 adverse events and treatment discontinuations were observed.
Conclusions:
- Perioperative PI integration with neoadjuvant chemotherapy enhances survival and pathological outcomes in resectable NSCLC.
- Careful evaluation of increased adverse events is necessary.
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