Efficacy, safety, and survival of neoadjuvant immunochemotherapy in operable non-small cell lung cancer: a systematic review and meta-analysis

Yue Zheng; Baijie Feng; Jingyao Chen; Liting You

doi:10.3389/fimmu.2023.1273220

Efficacy, safety, and survival of neoadjuvant immunochemotherapy in operable non-small cell lung cancer: a systematic review and meta-analysis

Front Immunol. 2023 Dec 1:14:1273220. doi: 10.3389/fimmu.2023.1273220. eCollection 2023.

Authors

Yue Zheng^#¹, Baijie Feng^#¹, Jingyao Chen^#², Liting You³

Affiliations

¹ West China School of Medicine, Sichuan University, Chengdu, Sichuan, China.
² Precision Medicine Research Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
³ Department of Laboratory Medicine, West China Hospital, Sichuan University, TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.

^# Contributed equally.

Abstract

Background: Neoadjuvant immunochemotherapy may benefit patients with non-small cell lung cancer (NSCLC), but its impact requires further investigation.

Methods: A meta-analysis was conducted. PubMed, Embase, Web of Science, and the Cochrane Library were searched. The study was registered in PROSPERO (registration no. CRD42022360893).

Results: 60 studies of 3,632 patients were included. Comparing with neoadjuvant chemotherapy, neoadjuvant immunochemotherapy showed higher pCR (RR: 4.71, 95% CI: 3.69, 6.02), MPR (RR, 3.20, 95% CI: 2.75, 3.74), and ORR (RR, 1.46, 95% CI: 1.21, 1.77), fewer surgical complications (RR: 0.67, 95%CI: 0.48, 0.94), higher R0 resection rate (RR: 1.06, 95%CI: 1.03, 1.10, I² = 52%), and longer 1-year and 2-year OS, without affecting TRAEs. For neoadjuvant immunochemotherapy in NSCLC, the pooled pCR rate was 0.35 (95% CI: 0.31, 0.39), MPR was 0.59 (95% CI: 0.54, 0.63), and ORR was 0.71 (95% CI: 0.66, 0.76). The pooled incidence of all grade TRAEs was 0.70 (95% CI: 0.60, 0.81), and that of >= grade 3 TRAEs was 0.24 (95% CI: 0.16, 0.32). The surgical complications rate was 0.13 (95% CI: 0.07, 0.18) and R0 resection rate was 0.98 (95% CI: 0.96, 0.99). The pooled 1-year OS was 0.97 (95%CI: 0.96, 0.99), and 2-year OS was 0.89 (95%CI: 0.83, 0.94). Patients with squamous cell carcinoma, stage III or higher PD-L1 performed better. Notably, no significant differences were observed in pCR, MPR, and ORR between 2 or more treatment cycles. Pembrolizumab-, or toripalimab-based neoadjuvant immunochemotherapy demonstrated superior efficacy and tolerable toxicity.

Conclusion: According to our analysis, reliable efficacy, safety, and survival of neoadjuvant immunochemotherapy for operable NSCLC were demonstrated.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022360893, identifier CRD42022360893.

Keywords: efficacy; neoadjuvant immunochemotherapy; non-small cell lung cancer; safety; survival.

Publication types

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

MeSH terms

Carcinoma, Non-Small-Cell Lung* / therapy
Carcinoma, Squamous Cell*
Humans
Immunotherapy / adverse effects
Lung Neoplasms* / therapy
Neoadjuvant Therapy / adverse effects

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was supported by Department of Science and Technology of Sichuan Province (2022YFS0205), the Project of Sichuan Province Key Laboratory Open Funding (grant No.SZKF202210), Natural Science Foundation of Sichuan Province of China (2023NSFSC1883) and the 2024 College Students’ Innovative Entrepreneurial Training Plan Program (Project No. C2024130171).