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Treatment interruption during neoadjuvant immuno-chemotherapy for non-small-cell lung cancer: a systematic review and
Yi Liu1, Zhihao Wang2, Shuxiao Ma1
1Department of Thoracic Surgery and Institute of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, China.
Background:
Neoadjuvant immuno-chemotherapy has been verified as a promising treatment for early-stage non-small-cell lung cancer (NSCLC). However, its risk of pre-operative treatment interruption was unclear. This study aimed to evaluate and compare the risk of pre-operative treatment interruption between different neoadjuvant therapy (NAT) strategies in early-stage NSCLC.
Methods:
We searched MEDLINE, Embase, and the Cochrane Library for randomized controlled trials (RCTs) reporting on NAT in NSCLC up to July 3, 2024. Eligible studies reporting pre-operative treatment interruption were included. Paired meta-analysis and Bayesian network meta-analysis (NMA) were conducted to compare the risk between different NAT strategies. The primary outcome was pre-operative treatment interruption, which included neoadjuvant treatment discontinuation, surgery delay and surgery cancellation.
Results:
Compared with neoadjuvant chemotherapy, neoadjuvant immuno-chemotherapy was associated with a higher risk of adverse event (AE)-related NAT discontinuation [risk ratio (RR), 1.32; 95% confidence interval (CI): 1.00-1.73; I2=4%] and a lower risk of progressive disease (PD)-related NAT discontinuation (RR, 0.53; 95% CI: 0.30-0.96; I2=0%), but there was no significant difference in the overall risk of NAT discontinuation. Neoadjuvant immuno-chemotherapy was also associated with a lower risk of overall surgery cancellation (RR, 0.79; 95% CI: 0.70-0.90; I2=26%). The NMA further corroborated the aforementioned findings.
Conclusions:
Neoadjuvant immuno-chemotherapy did not increase the risk of NAT discontinuation and surgery delay. On the contrary, it is associated with a reduced risk of surgery cancellation, particularly in cases of cancellation due to PD. These findings suggested extra advantage of neoadjuvant immuno-chemotherapy in the management of early-stage NSCLC (CRD42024570066).
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