Systematic review and meta-analysis of neoadjuvant chemo-immunotherapy for early-stage non-small cell lung cancer

A systematic review and meta-analysis of the literature through November 1, 2023, evaluated addition of immune checkpoint inhibitors (ICIs) to neoadjuvant chemotherapy for early stage (IB-IIIB) non-small cell lung cancer. Eight phase 2 or 3 randomized controlled trials including 3387 patients were identified. Neoadjuvant ICI-chemotherapy versus chemotherapy alone was associated with improved 2-year event-free survival (HR 0.57; p<0.001) and increased pCR rate (RR 5.58; p<0.001). These associations were not significantly modified PD-L1 status, platinum compound chemotherapy, number of neoadjuvant ICI-chemotherapy cycles, or addition of adjuvant ICIs. The authors conclude that among patients with early-stage NSCLC, addition of ICIs to neoadjuvant chemotherapy was associated with improvements in 2-year EFS and pCR.