Evaluation of neoadjuvant immunotherapy plus chemotherapy in Chinese surgically resectable gastric cancer: a pilot study by meta-analysis

Hao Xu; Tengyun Li; Guoyi Shao; Weizhi Wang; Zhongyuan He; Jianghao Xu; Yawei Qian; Hongda Liu; Han Ge; Linjun Wang; Diancai Zhang; Li Yang; Fengyuan Li; Zekuan Xu

doi:10.3389/fimmu.2023.1193614

Evaluation of neoadjuvant immunotherapy plus chemotherapy in Chinese surgically resectable gastric cancer: a pilot study by meta-analysis

Front Immunol. 2023 Jun 23:14:1193614. doi: 10.3389/fimmu.2023.1193614. eCollection 2023.

Authors

Hao Xu^{1

2}, Tengyun Li^{1

2}, Guoyi Shao³, Weizhi Wang^{1

2}, Zhongyuan He^{1

2}, Jianghao Xu^{1

2}, Yawei Qian^{1

2}, Hongda Liu^{1

2}, Han Ge^{1

2}, Linjun Wang^{1

2}, Diancai Zhang^{1

2}, Li Yang^{1

2}, Fengyuan Li^{1

2}, Zekuan Xu^{1

2}

Affiliations

¹ Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
² Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center for Cancer Personalized Medical University, Nanjing, China.
³ Department of General Surgery, Jiangyin People's Hospital Affiliated to Nantong University, Wuxi, China.

Abstract

Background: Recently, the use of immunochemotherapy in the treatment of advanced gastric cancer (GC) has been increasing and programmed cell death protein 1 (PD-1) inhibitors combined with chemotherapy has become the first-line treatment for advanced GC. However, few studies with small sample sizes have examined this treatment regimen to assess its effectiveness and safety in the neoadjuvant treatment phase of resectable local advanced GC.

Materials and methods: Herein, we systematically searched PubMed, Cochrane CENTRAL, and Web of Science for clinical trials on neoadjuvant immunochemotherapy (nICT) in advanced GC. The primary outcomes were effectiveness [evaluated by major pathological response (MPR) and pathological complete response (pCR)] and safety [assessed by grade 3-4 treatment-related adverse events (TRAEs) and postoperative complications]. A meta-analysis of non-comparative binary results was performed to aggregate the primary outcomes. Direct comparative analysis was used to compare pooled results of neoadjuvant chemotherapy (nCT) with nICT. The outcomes emerged as risk ratios (RR).

Results: Five articles with 206 patients were included, and all of them were from the Chinese population. The pooled pCR and MPR rates were 26.5% (95% CI: 21.3%-33.3%) and 49.0% (95% CI: 42.3%-55.9%), while grade 3-4 TRAEs and post-operative complication rates were 20.0% (95% CI: 9.1%-39.8%) and 30.1% (95% CI: 23.1%-37.9%), respectively. Direct comparison showed that with the exception of grade 3-4 TRAEs and postoperative complications, all outcomes including pCR, MPR, and R0 resection rate favoured nICT to nCT.

Conclusion: nICT is a promising strategy for use as an advisable neoadjuvant treatment for patients with advanced GC in Chinese population. However, more phase III randomized controlled trials (RCTs) will be required to further consolidate the efficacy and safety of this regimen.

Keywords: meta – analysis; neoadjuant chemotherapy; neoadjuvant immunochemotherapy; perioperative immunotherapy; resectable advanced gastric cancer.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

East Asian People
Humans
Immunotherapy*
Neoadjuvant Therapy*
Pilot Projects
Postoperative Complications
Stomach Neoplasms* / therapy

Grants and funding

This work was supported grants from National Natural Science Foundation of China (grant number: 82072708); Youth Program of National Natural Science Foundation of China (grant number: 81902461).