Efficacy of neoadjuvant PD-1/PD-L1 inhibitor in resectable NSCLC: a meta-analysis based on randomized controlled
Weiming Zhang1, Tianfu Dai2, Dongying Wang2,3
1Department of Pulmonary and Critical Care Medicine, Longyan People Hospital of Fujian, Longyan, Fujian, China.
Background:
The efficacy of neoadjuvant immunotherapy in resectable non-small-cell lung cancer (NSCLC) is controversial. The aim of this study is to explore the efficacy of additional PD-1/PD-L1 inhibitors in the neoadjuvant treatment of resctable NSCLC.
Methods:
Data sources included Cochrane Library, Embase, Web of Science, and PubMed from beginning of the database creation to May 2024. The primary outcomes of the study included event-free survival (EFS), overall survival (OS), pathological complete response (pCR), major pathological response (MPR).
Results:
Seven RCTs, including 2929 patients, were included in the analysis. The results showed that the experimental group had significantly higher rates of pCR (RR = 5.9, p < 0.001) and MPR (RR = 2.88, p < 0.001) compared to the control group. OS (HR = 0.57) and EFS (HR = 0.58) was also significantly improved in the experimental group. Subgroup analysis of EFS revealed that the benefit was higher in the East (HR = 0.56) than in the West (HR = 0.70). Additionally, the benefit seemed to rise with PD-L1 tumor cell proportion score (TPS) (TPS < 1%, HR = 0.76; 1% < TPS < 49%, HR = 0.56; TPS ≥ 50%, HR = 0.38). The benefit degree seemed to be higher in the III period patients (HR = 0.75) than I-II period patients (HR = 0.52). It is important to emphasize that smokers (HR = 0.54, p < 0.001) benefited from neoadjuvant immunotherapy but nonsmokers (HR = 0.68, p = 0.055) did not.
Conclusion:
Neoadjuvant PD-1/PD-L1 inhibitor combined with chemotherapy can significantly improve the short-term and long-term prognosis of patients with resectable NSCLC. Moreover, the efficacy of this treatment regimen may be affected by different clinicopathological characteristics of patients.
Insights
Neoadjuvant immunotherapy with PD-1/PD-L1 inhibitors significantly improves outcomes for resectable non-small-cell lung cancer. This approach enhances event-free survival, overall survival, and pathological response rates in patients.
Area of Science:
- Oncology
- Immunotherapy
- Thoracic Surgery
Background:
- The role of neoadjuvant immunotherapy in resectable non-small-cell lung cancer (NSCLC) remains debated.
- Investigating the efficacy of adding PD-1/PD-L1 inhibitors to neoadjuvant treatment for resectable NSCLC is crucial.
Purpose of the Study:
- To evaluate the efficacy of neoadjuvant immunotherapy, specifically PD-1/PD-L1 inhibitors combined with chemotherapy, in patients with resectable non-small-cell lung cancer.
- To analyze the impact of this regimen on event-free survival (EFS), overall survival (OS), pathological complete response (pCR), and major pathological response (MPR).
Main Methods:
- A systematic review and meta-analysis of seven randomized controlled trials (RCTs) involving 2929 patients.
- Data were sourced from Cochrane Library, Embase, Web of Science, and PubMed up to May 2024.
- Primary outcomes included EFS, OS, pCR, and MPR.
Main Results:
- Neoadjuvant PD-1/PD-L1 inhibitor plus chemotherapy significantly increased pCR (RR=5.9) and MPR (RR=2.88) rates.
- Overall survival (HR=0.57) and event-free survival (HR=0.58) were significantly improved.
- Subgroup analyses indicated greater benefits in Eastern populations, patients with higher PD-L1 expression (TPS ≥50%), stage III disease, and smokers.
Conclusions:
- Neoadjuvant PD-1/PD-L1 inhibitor combined with chemotherapy offers significant short-term and long-term survival benefits for resectable NSCLC.
- Treatment efficacy is influenced by patient clinicopathological characteristics, including PD-L1 expression, disease stage, and smoking status.
