Neoadjuvant or Perioperative Immunotherapy in Resectable Non-Small Cell Lung Cancer: Pooled Analysis of Subgroups in Randomized Controlled Trial
Objectives: This meta-analysis evaluates the efficacy of adding Anti-PD-1 or Anti-PD-L1 agents (ICI) to platinum-based chemotherapy in perioperative/neoadjuvant systemic therapy for resectable non-small cell lung cancer (NSCLC), focusing on specific subgroup outcomes.
Methods: Databases like PUBMED, Cochrane, and EMBASE, along with trials presented at major congresses until March 01, 2024, were screened for RCTs on perioperative or neoadjuvant ICI in resectable NSCLC.
Results: Eight RCTs involving 3387 patients were analyzed. The ICI arm showed significantly higher pCR rates (24.3% vs 4.0%; OR: 7.68, 95% CI 5.88-10.04, I2: 41%, p<0.001). Subgroup analyses based on age, smoking, gender, histology, stage, platinum agent, and PD-L1 levels consistently showed higher pCR rates in the ICI arm. Neoadjuvant ICI trials demonstrated significantly prolonged EFS in the ICI arm (HR: 0.66, 95% CI 0.48-0.89, I2: 0%, p<0.01). Perioperative ICI trials also showed significantly prolonged EFS (HR: 0.57, 95% CI 0.50-0.65, I2: 19%, p<0.01). Better EFS outcomes were observed across all subgroups except never-smokers. Additionally, perioperative ICI trials showed significantly prolonged OS in the ICI arm (HR: 0.66, 95% CI 0.53-0.81, I2: 0%, p<0.01).
Conclusion: Adding ICI to platinum-based systemic therapy in the perioperative or neoadjuvant treatment of resectable NSCLC significantly improves pCR, EFS, and OS.
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