Efficacy and safety of neoadjuvant immunotherapy in resectable nonsmall cell lung cancer: A meta-analysis

Objective: Progress in neoadjuvant therapy for resectable nonsmall cell lung cancer(NSCLC¹)has been stagnant. There have been great achievements in immunotherapy for advanced NSCLC, but the efficacy and safety of neoadjuvant immunotherapy for resectable NSCLC has not been clearly demonstrated.

Methods: Original articles describing the safety and efficacy of neoadjuvant immunotherapy in resectable NSCLC published before January 2020 were retrieved from PubMed, Embase and Cochrane Library. The odds ratio (OR²) and 95 % confidence interval (CI³) were calculated. Heterogeneity and subgroup analysis were performed.

Results: A total of 252 patients from seven studies were included. Major pathological response (MPR⁴) and pathological complete response (pCR⁵) were used to evaluate the efficacy of neoadjuvant immunotherapy. Compared with neoadjuvant chemotherapy, which exhibited less than 25 % MPR and approximately 2 %-15 % pCR, the values in neoadjuvant immunotherapy were significantly higher (MPR: OR = 0.59; 95 % CI, 0.36-0.98; pCR: OR = 0.16; 95 % CI, 0.09-0.27). Safety was evaluated by the incidence of treatment-related adverse events (TRAE⁶), surgical resection rate, incidence of surgical complications and surgical delay rate. The pooled OR values of the incidence of TRAE, incidence of surgical complications and surgical delay rate were 0.19, 0.41 and 0.03, respectively, which were significantly better than those for neoadjuvant chemotherapy (95 % CI, 0.04-0.90; 0.22-0.75; 0.01-0.10, respectively). The mean surgical resection rate was 88.70 %, which was similar to the 75 %-90 % rate reported for neoadjuvant chemotherapy (OR = 7.61; 95 % CI, 4.90-11.81).

Conclusion: Neoadjuvant immunotherapy is effective and safe for resectable NSCLC.