Meta-analysis of neoadjuvant-adjuvant versus neoadjuvant only PD-(L)1 inhibition for resectable non-small cell lung cancer

Neoadjuvant therapy combining PD-(L)1 inhibitors with platinum-based chemotherapy has demonstrated significant improvement in outcomes over chemotherapy alone among patients with resectable non-small cell lung cancer (NSCLC). However, it remains controversial whether PD-(L)1 blockade therapy given before and after surgery (neoadjuvant-adjuvant treatment) is associated with better outcomes than when given only before surgery (neoadjuvant-only treatment). In a meta-analysis of five randomized trials involving 2385 patients with resectable NSCLC, the addition of PD-(L)1 inhibitors in the adjuvant phase, alongside neoadjuvant PD-(L)1 inhibitors and chemotherapy, was not associated with a significant improvement in event-free survival or overall survival. Neoadjuvant-adjuvant treatment was also associated with an increase in treatment-related adverse events. The authors conclude that adding adjuvant immunotherapy may not improve clinical outcomes for patients with early-stage NSCLC who receive neoadjuvant PD-(L)1 inhibitors plus chemotherapy and undergo radical surgery.