Chemoimmunotherapy is superior to chemotherapy as neoadjuvant treatment for advanced, resectable non-small cell lung cancer (NSCLC), according to results of a meta-analysis published in Cancer.
Researchers found that neoadjuvant chemoimmunotherapy can improve response rates and survival outcomes without increasing toxicity.
This meta-analysis included studies of patients with resectable stage I-III NSCLC treated with neoadjuvant immune checkpoint inhibitors alone or combined with chemotherapy or radiotherapy. Sixty-six studies met inclusion criteria, including 8 randomized studies, 39 prospective nonrandomized studies, and 19 retrospective studies.
Of the 66 studies, 59 reported pathologic complete response (pCR) data. The pooled pCR rate was 28.1%. The rate of grade 3 or higher treatment-related adverse events in these patients was 18.0%.
Thirteen of the studies had comparative data, most commonly for neoadjuvant chemoimmunotherapy compared with neoadjuvant chemotherapy (9 studies). Patients who received chemoimmunotherapy were more likely to achieve a pCR than those who received chemotherapy (odds ratio [OR], 7.63; 95% CI, 4.49-12.97; P <.001).
Patients who received chemoimmunotherapy also had a lower risk of death than those who received chemotherapy (hazard ratio [HR], 0.51; 95% CI, 0.36-0.74; P <.001).
The researchers grouped disease-free survival, progression-free survival, event-free survival, and recurrence-free survival together and found that this combined endpoint was improved with chemoimmunotherapy as well (HR, 0.51; 95% CI, 0.38-0.67; P <.001).
A comparison of grade 3 or higher treatment-related adverse events showed similar rates for chemoimmunotherapy and chemotherapy (OR, 1.01; 95% CI, 0.67-1.52; P =.97).
The researchers noted that these results are in line with the findings of Checkmate-816 (ClinicalTrials.gov identifier: NCT02998528), which supported the use of neoadjuvant chemoimmunotherapy as a standard of care option for resectable NSCLC.
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Wu Y, Verma V, Gay CM, et al. Neoadjuvant immunotherapy for advanced, resectable non-small cell lung cancer: A systematic review and meta-analysis. Cancer. Published online March 30, 2023. doi:10.1002/cncr.34755