In a systematic review and meta-analysis reported in JAMA Network Open, Banna et al found that neoadjuvant chemoimmunotherapy was associated with improved event-free survival and pathologic complete response compared with neoadjuvant chemotherapy alone in patients with early-stage non–small cell lung cancer (NSCLC).
Study Details
A search through November 2023 identified eight phase II to III randomized trials involving 3,387 patients that were comparing three or four cycles of neoadjuvant immune checkpoint inhibitor therapy plus platinum-based chemotherapy with or without adjuvant immune checkpoint inhibitors vs neoadjuvant platinum-based chemotherapy alone with or without placebo in patients with stage IB to IIIB disease. The primary outcome measures of the trials were 2-year event-free survival and pathologic complete response.
Key Findings
Neoadjuvant immune checkpoint inhibition plus chemotherapy was associated with improved 2-year event-free survival (hazard ratio [HR] = 0.57, 95% confidence interval [CI] = 0.50–0.66, P < .001) vs chemotherapy alone, irrespective of sex, age, Eastern Cooperative Oncology Group (ECOG) performance status, smoking history, histologic features, tumor stage, and type of platinum-based chemotherapy.
Hazard ratios (HRs) favored combination immune checkpoint inhibition and chemotherapy among patients with negative PD-L1 expression (HR = 0.75, 95% CI = 0.62–0.91), low PD-L1 expression (HR = 0.51, 95% CI = 0.37–0.71), and high PD-L1 expression (HR = 0.40, 95% CI = 0.27–0.58), although there were differences in outcomes (overall P = .005).
Neoadjuvant immune checkpoint inhibition plus chemotherapy was associated with improved pathologic complete response rate (relative risk = 5.58, 95% CI = 4.27–7.29, P < .001) vs chemotherapy alone, irrespective of sex, age, ECOG performance status, smoking history, histologic features, PD-L1 tumor status, tumor stage, and type of platinum-based chemotherapy.
The investigators concluded, “In this systematic review and meta-analysis of neoadjuvant immune checkpoint inhibition and chemotherapy randomized controlled trials in patients with early-stage NSCLC … neoadjuvant immune checkpoint inhibition plus platinum-based chemotherapy was associated with a meaningful improvement in 2-year event-free survival and pathologic complete response.”
Giuseppe Luigi Banna, MD, of Portsmouth Hospitals University NHS Trust, is the corresponding author for the JAMA Network Open article.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
