Real-World Effectiveness and Prognostic Factors Analysis of Stages I–III Non-Small Cell Lung Cancer Following Neoadjuvant Chemo-Immunotherapy or Neoadjuvant Chemotherapy

Zuo, Li; Gao, Zhaoming; Zhang, Mengzhe; Wang, Xiaofei; Gong, Jialin; Jiang, Shuai; Zhang, Zhenfa

doi:10.5761/atcs.oa.21-00143

Cited by 11 publications

(11 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…After PSM, the MPR rate of the PD‐1 + Chemo group was 48.4%, which was significantly higher than that of the Chemo group (17.2%). In accordance with previous reports, 6,7,15–24 MPR rates ranged from 27% to 86% in the chemoimmunotherapy modality, while the range was 8.9% to 16% with neoadjuvant chemotherapy alone. Several studies 16,22 have reported relatively higher MPR rates in squamous cell carcinoma patients.…”

Section: Discussionsupporting

confidence: 92%

“… 18 Zhai et al 20 reported in a retrospective analysis that the 24‐month PFS was 45.8% and the OS rate was 79.9% after neoadjuvant nivolumab and chemotherapy. In another real‐world analysis from China, 21 the 2‐year DFS rate was 81.8% in the MPR groups, while it was 37.3% in the non‐MPR group; multivariate analysis identified maximal tumor length of the specimen, ypN1‐2, and non‐MPR pathological evaluation as independent factors affecting poor prognosis. Our analysis also confirmed that surgical radicality and pathological response were both independent prognostic factors for DFS.…”

Section: Discussionmentioning

confidence: 95%

See 1 more Smart Citation

A real‐world comparison between neoadjuvant chemoimmunotherapy and chemotherapy alone for resectable non‐small cell lung cancer

Zhang

Xiao

et al. 2022

Cancer Medicine

View full text Add to dashboard Cite

Background The impact of neoadjuvant chemoimmunotherapy on pulmonary resection and related outcomes had been poorly reported in previous studies. The present study aims to clarify the efficacy and safety of neoadjuvant chemoimmunotherapy, and intraoperative difficulty in the following surgery, in comparison with chemotherapy alone in non‐small cell lung cancer (NSCLC). Methods Patients with newly diagnosed clinical stages IB–IIIB(T3‐4N2) NSCLC, received neoadjuvant chemotherapy + PD‐1 inhibitors (PD‐1 + Chemo group) or chemotherapy alone (Chemo group) followed by surgery between December 2018 and December 2020 were included. The clinicopathological characteristics were retrospectively reviewed and analyzed. Results There were 69 NSCLC patients in the PD‐1 + Chemo group and 121 in the Chemo group. The major pathological response (MPR) rate in the PD‐1 + Chemo group was 49.3%, higher than that of 19.0% in the Chemo group ( p < 0.001). The 2‐year disease‐free survival (DFS) rate was 79.3% and 60.2%, respectively, in the two groups ( p = 0.048). Multivariate analysis identified surgical radicality (hazard ratio (HR), 2.954, 95% confidence interval (CI), 1.527–5.714, p = 0.001), and pathological response (MPR(CR) vs. SD(PD), HR, 0.248, 95% CI, 0.107–0.572, p = 0.001) to be independent prognostic factors for DFS. Lobectomy was performed in 73.9% and 66.1% of patients, respectively, and bronchial sleeve resection/bronchoplasty rate was also comparable (43.4% vs. 40.5%, p = 0.688). More patients in the PD‐1 + Chemo group received vascular sleeve resection/angioplasty (15.9% vs. 6.6%, p = 0.039) and pericardial resection (10.1% vs. 2.5%, p = 0.038). After propensity score matching analysis, pericardial resection rate was still slightly higher in the PD‐1 + Chemo group (9.4% vs. 1.6%, p = 0.05). Perioperative morbidities within 30 days and mortality in 90 days were comparable between groups ( p > 0.05). Conclusions Neoadjuvant chemoimmunotherapy for NSCLC is safe and feasible, with higher MPR rates, as well as favorable DFS than chemotherapy alone. Surgical complexity might be increased in certain patients, with comparable perioperative morbidity and mortality.

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 95%

A real‐world comparison between neoadjuvant chemoimmunotherapy and chemotherapy alone for resectable non‐small cell lung cancer

Zhang

Xiao

et al. 2022

Cancer Medicine

View full text Add to dashboard Cite

show abstract

“…There was high interrater agreement in terms of study selection (κ = 0.979; p = .021). Table 1 displays pertinent details of each study 13–78 ; patients most commonly had stage III disease and received two to four cycles of various ICIs.…”

Section: Resultsmentioning

confidence: 99%

Neoadjuvant immunotherapy for advanced, resectable non–small cell lung cancer: A systematic review and meta‐analysis

Verma

Gay

et al. 2023

Cancer

View full text Add to dashboard Cite

Background Neoadjuvant immunotherapy (nIT) is a rapidly emerging paradigm for advanced resectable non‐small cell lung cancer (NSCLC). The objectives of this PRISMA/MOOSE/PICOD‐guided systematic review and meta‐analysis were (1) to assess the safety and efficacy of nIT, (2) to compare the safety and efficacy of neoadjuvant chemoimmunotherapy (nCIT) versus chemotherapy alone (nCT), and (3) to explore predictors of pathologic response with nIT and their association with outcomes. Methods Eligibility was resectable stage I–III NSCLC and the receipt of programmed death‐1/programmed cell death ligand‐1 (PD‐L1)/cytotoxic T‐lymphocyte–associated antigen‐4 inhibitors before resection; other forms and modalities of neoadjuvant and/or adjuvant therapies were allowed. For statistical analysis, the Mantel–Haenszel fixed‐effect or random‐effect model was used, depending on the heterogeneity (I2). Results Sixty‐six articles met the criteria (eight randomized studies, 39 prospective nonrandomized studies, and 19 retrospective studies). The pooled pathologic complete response (pCR) rate was 28.1%. The estimated grade ≥3 toxicity rate was 18.0%. Compared with nCT, nCIT achieved higher rates of pCR (odds ratio [OR], 7.63; 95% confidence interval [CI], 4.49–12.97; p < .001), progression‐free survival (PFS) (hazard ratio [HR] 0.51; 95% CI, 0.38–0.67; p < .001), and overall survival (OS) (HR, 0.51; 95% CI, 0.36–0.74; p = .0003) but yielded similar toxicity rates (OR, 1.01; 95% CI, 0.67–1.52; p = .97). The results remained robust on sensitivity analysis when all retrospective publications were removed. pCR was associated with improved PFS (HR, 0.25; 0.15–0.43; p < .001) and OS (HR, 0.26; 95% CI, 0.10–0.67; p = .005). PD‐L1 expressors (≥1%) were more likely to achieve a pCR (OR, 2.93; 95% CI, 1.22–7.03; p = .02). Conclusions In patients with advanced resectable NSCLC, neoadjuvant immunotherapy was safe and efficacious. nCIT improved pathologic response rates and PFS/OS over nCT, particularly in patients who had tumors that expressed PD‐L1, without increasing toxicities. Plain Language Summary This meta‐analysis of 66 studies showed that neoadjuvant immunotherapy for advanced resectable non‐small cell lung cancer is safe and efficacious. Compared with chemotherapy alone, chemoimmunotherapy improved pathologic response rates and survival, particularly for patients who had tumors that expressed programmed cell death ligand‐1, without increasing toxicities.

show abstract

“…The CHECKMATE-816 study confirmed that the application of NICT in NSCLC patients could improve the EFS of patients as compared with that of NCT. However, the real-world data comparing NICT with NCT is still relatively limited ( 19 , 20 ). Therefore, the current study compared the data of dual-center NICT with NCT.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of neoadjuvant immunochemotherapy compared to neoadjuvant chemotherapy in non-small cell lung cancer patients: Real-world data of a retrospective, dual-center study

et al. 2023

View full text Add to dashboard Cite

BackgroundStudying the application of neoadjuvant immunochemotherapy (NICT) in the real world and evaluating its effectiveness and safety in comparison with neoadjuvant chemotherapy (NCT) are critically important.MethodsThis study included the II-IIIB stage non-small cell lung cancer (NSCLC) patients receiving NCT with or without PD-1 inhibitors and undergoing surgery after neoadjuvant treatments between January 2019 to August 2022. The clinical characteristics and treatment outcomes were retrospectively reviewed and analyzed.ResultsA total of 66 patients receiving NICT and 101 patients receiving NCT were included in this study. As compared to NCT, NICT showed similar safety while not increasing the surgical difficulty. The ORR in the NICT and NCT groups was 74.2% and 53.5%, respectively, P = 0.009. A total of 44 patients (66.7%) in the NICT group and 21 patients (20.8%) in the NCT group showed major pathology response (MPR) (P <0.001). The pathology complete response (pCR) rate was also significantly higher in NICT group than that in NCT group (45.5% vs. 10.9%, P <0.001). After Propensity Score Matching (PSM), 42 pairs of patients were included in the analysis. The results showed no significant difference in the ORR between the two groups (52.3% vs. 43.2%, P = 0.118), and the proportions of MPR (76.2%) and pCR (50.0%) in NICT group were significantly higher than those of MPR (11.9%) and pCR (4.7%) in the NCT group (P <0.001). The patients with driver mutations might also benefit from NICT.ConclusionsAs compared to NCT, the NICT could significantly increase the proportions of patients with pCR and MPR without increasing the operation-related bleeding and operation time.

show abstract

Real-World Effectiveness and Prognostic Factors Analysis of Stages I–III Non-Small Cell Lung Cancer Following Neoadjuvant Chemo-Immunotherapy or Neoadjuvant Chemotherapy

Cited by 11 publications

References 30 publications

A real‐world comparison between neoadjuvant chemoimmunotherapy and chemotherapy alone for resectable non‐small cell lung cancer

A real‐world comparison between neoadjuvant chemoimmunotherapy and chemotherapy alone for resectable non‐small cell lung cancer

Neoadjuvant immunotherapy for advanced, resectable non–small cell lung cancer: A systematic review and meta‐analysis

Effectiveness of neoadjuvant immunochemotherapy compared to neoadjuvant chemotherapy in non-small cell lung cancer patients: Real-world data of a retrospective, dual-center study

Contact Info

Product

Resources

About