Meta-Analysis of Neoadjuvant Immunotherapy for Patients with Resectable Non-Small Cell Lung Cancer

Abstract

Purpose: Immunotherapy has created a paradigm shift in the treatment of metastatic non-small cell lung cancer (NSCLC), overcoming the therapeutic plateau previously achieved by systemic chemotherapy. There is growing interest in the utility of immunotherapy for patients with resectable NSCLC in the neoadjuvant setting. The present systematic review and meta-analysis aim to provide an overview of the existing evidence, with a focus on pathological and radiological response, perioperative clinical outcomes, and long-term survival. Methods: A systematic review was conducted using electronic databases from their dates of inception to August 2021. Pooled data on pathological response, radiological response, and perioperative outcomes were meta-analyzed where possible. Results: Eighteen publications from sixteen studies were identified, involving 548 enrolled patients who underwent neoadjuvant immunotherapy, of whom 507 underwent surgery. Pathologically, 52% achieved a major pathological response, 24% a complete pathological response, and 20% reported a complete pathological response of both the primary lesion as well as the sampled lymph nodes. Radiologically, 84% of patients had stable disease or partial response. Mortality within 30 days was 0.6%, and morbidities were reported according to grade and frequency. Conclusion: The present meta-analysis demonstrated that neoadjuvant immunotherapy was feasible and safe based on perioperative clinical data and completion rates of surgery within their intended timeframe. The pathological response after neoadjuvant immunotherapy was superior to historical data for patients who were treated with neoadjuvant chemotherapy alone, whilst surgical and treatment-related adverse events were comparable. The limitations of the study included the heterogenous treatment regimens, lack of long-term follow-up, variations in the reporting of potential prognostic factors, and potential publication bias.

Updated Prognostic Factors in Localized NSCLC

“…Trials and meta-analysis have been published in the neoadjuvant situation [121,122]. The latest meta-analysis by Ulas et al included 1066 patients among 19 recent studies.…”

Neoadjuvant immunotherapy and neoadjuvant chemotherapy in resectable non-small cell lung cancer: A systematic review and single-arm meta-analysis

“…Several previous meta-analyses (65)(66)(67)(68)(69)(70) have also evaluated neoadjuvant immunotherapy in NSCLC (Supplementary File: Table S7). Among them, the largest two studies (65, 66) which were published in 2022 included 21 trials with 792 patients (65) and 15 trials with 809 patients (66), respectively.…”

International expert consensus on immunotherapy for early-stage non-small cell lung cancer

“…In CheckMate 816, NADIM, SAKK16/14, NCT02716038 and NEOSTAR, surgery was performed 3–7 weeks after the completion of the neoadjuvant treatment ( 22 , 25 - 27 , 36 , 46 ). A recent meta-analysis ( 63 ) included 18 publications from 16 studies, in which a total of 548 NSCLC patients received neoadjuvant immunotherapy, 507 of whom underwent surgery. The interval from the final dose of immunotherapy to the surgery was 27–32 days, and 2.0% of patients had their surgery delayed.…”