358P Adjuvant tyrosine kinase inhibitors in non-squamous non-small cell lung cancer with EGFR driver mutations: An updated meta-analysis of randomized trials

Abstract

neoadjuvant immunotherapy and neoadjuvant chemotherapy upon multiple shortterm outcome.Results: This systematic review and meta-analysis included 10 trials of neoadjuvant immunotherapy and 11 neoadjuvant chemotherapy involving 1755 patients. Patients received PD-1/PD-L1 inhibitors alone (13.3%; 95%CI, 9.0%-19.3%) had lower objective response rate (ORR) compared to PD-1/PD-L1 inhibitors plus chemotherapy (62.5%; 95%CI, 54.4%-70.0%) or chemotherapy (41.6%; 95%CI, 36.8%-46.7%) while neoadjuvant PD-1/PD-L1 inhibitors plus chemotherapy (36.2%; 95%CI, 19.2%-57.6%) achieved elevated complete pathological complete response (pCR) eclipsing PD-1/PD-L1 inhibitors alone (10.6%; 95%CI, 6.5%-16.9%) and standard chemotherapy (7.5%; 95%CI, 5.7%-9.8%). Neoadjuvant chemotherapy (87.2%; 95%CI, 74.9%-94.0%) has numerically lower R0 resection rate in contrast to neoadjuvant PD-1/PD-L1 inhibitors alone (92.7%; 95%CI, 83.4%-97.0%) and PD-1/PD-L1 inhibitors plus chemotherapy (91.6%; 95%CI, 84.3%-95.7%). Subgroup analysis showed that increased proportion of stage III patients receiving neoadjuvant chemotherapy (p¼0.025, Spearman r¼0.761) may be correlated with lower R0 resection rate while no significant correlation was found in PD-1/PD-L1-based neoadjuvant treatment.Conclusions: Compared to neoadjuvant chemotherapy, immunotherapy-based regimens provided superior pathological response along with higher complete resection rate especially for stage III disease. Immunotherapy combined chemotherapy as neoadjuvant setting may be a more preferable clinical option currently.