Systematic review and meta-analysis of neoadjuvant chemoimmunotherapy for non-small cell lung cancer

To date, no meta-analyses have comprehensively assessed the association of neoadjuvant chemoimmunotherapy with clinical outcomes in non-small cell lung cancer (NSCLC). In addition, there exists controversy concerning the efficacy of neoadjuvant chemoimmunotherapy for patients with NSCLC with PD-L1 levels less than 1%. A systematic review and meta-analysis of 8 randomized clinical trials comprising 3387 patients comparing neoadjuvant chemoimmunotherapy versus neoadjuvant chemotherapy found a pooled overall survival (HR 0.65; 95% CI 0.54-0.79), event-free survival (0.59; 0.52-0.67), major pathological response (RR 3.42; 2.83-4.15), and complete pathological response (5.52; 4.25-7.15) favoring neoadjuvant chemoimmunotherapy over neoadjuvant chemotherapy. For patients with PD-L1 levels less than 1%, there was a significant benefit in event-free survival for neoadjuvant chemoimmunotherapy compared with neoadjuvant chemotherapy (HR 0.74; 95% CI 0.62-0.89), but not in overall survival. The authors conclude that neoadjuvant chemoimmunotherapy was superior to neoadjuvant chemotherapy across surgical, pathological, and efficacy outcomes.