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Published on: September 25, 2018
Neoadjuvant Chemoimmunotherapy in Resectable NSCLC With PD-L1 Expression < 1%: A Systematic Review and Network
Isadora Mamede1, Skyler Taylor2, Rafael Lara Nohmi3
1School of Medicine, Federal University of São João del Rei, Divinópolis, Brazil.
Clinical Lung Cancer
|June 5, 2026
Summary
Chemoimmunotherapy in resectable non-small cell lung cancer (NSCLC) with low PD-L1 expression improves pathological response but does not significantly improve survival. Nivolumab plus chemotherapy showed the best pathological response, though no single strategy proved superior.
Area of Science:
- Oncology
- Immunotherapy
- Thoracic Surgery
Background:
- Neoadjuvant/perioperative chemoimmunotherapy benefits in resectable non-small cell lung cancer (NSCLC) with programmed death ligand 1 (PD-L1) < 1% are uncertain.
- Evidence primarily stems from subgroup analyses, necessitating further investigation.
Purpose of the Study:
- To systematically review and network meta-analyze chemoimmunotherapy regimens for resectable NSCLC with PD-L1 < 1%.
- To compare the efficacy of individual chemoimmunotherapy regimens in this specific patient subgroup.
Main Methods:
- Systematic review and Bayesian random-effects network meta-analysis of randomized controlled trials.
- Inclusion criteria: resectable NSCLC, PD-L1 < 1% subgroup outcomes reported.
- Outcomes assessed: event-free survival, overall survival, pathological complete response, major pathological response.
Main Results:
- Eight trials (3387 patients, 1012 with PD-L1 < 1%) were analyzed.
- No chemoimmunotherapy regimen significantly improved event-free or overall survival versus chemotherapy alone.
- Nivolumab plus chemotherapy demonstrated a significant improvement in pathological complete response (OR 5.88).
Conclusions:
- Chemoimmunotherapy enhances pathological response in resectable NSCLC with PD-L1 < 1% but lacks demonstrated survival benefit.
- Nivolumab plus chemotherapy shows promising pathological response, but no single immunotherapy strategy is definitively superior.
- Chemotherapy alone consistently ranked lowest across efficacy endpoints.
