Meta-analysis of value of neoadjuvant chemo-immunotherapy for patients with resectable NSCLC with PD-L1 expression less than 1%

The clinical benefit of neoadjuvant chemo-immunotherapy (nCIT) among patients with resectable NSCLC with PD-L1 expression less than 1% is not clear. A meta-analysis of six randomized controlled trials (3,194 patients) found that among patients with PD-L1 expression less than 1%, nCIT compared with neoadjuvant chemotherapy (nCT) was associated with improved pathological complete response, major pathologic response, and event-free survival. In comparison between patients with PD-L1 expression ≥ 1% versus PD-L1 expression < 1%, nCIT was associated with improved pCR, MPR, and EFS. nCIT improved overall survival only in patients with PD-L1 expression ≥ 1% but not in patients with PD-L1 < 1%. The authors conclude that use of nCIT should be recommended for resectable NSCLC patients with PD-L1 expression less than 1%.