In a systematic review and meta-analysis reported in JAMA Oncology, Sorin et al found that neoadjuvant chemoimmunotherapy was associated with better outcomes than neoadjuvant chemotherapy in patients with non–small cell lung cancer (NSCLC).
Study Details
A search of published studies reported between January 2013 and October 2023 identified eight randomized trials of neoadjuvant chemoimmunotherapy and chemotherapy, including a total of 3,387 patients.
Key Findings
The neoadjuvant chemoimmunotherapy group had significantly better outcomes vs the neoadjuvant chemotherapy group for pooled overall survival (hazard ratio [HR] = 0.65, 95% confidence interval [CI] = 0.54–0.79), event-free survival (HR = 0.59, 95% CI = 0.52–0.67), major pathologic response rate (risk ratio [RR] = 3.42, 95% CI = 2.83–4.15), and complete pathologic response rate (RR = 5.52, 95% CI = 4.25–7.15).
Among patients with PD-L1 expression < 1%, neoadjuvant chemoimmunotherapy was associated with significantly better event-free survival (HR = 0.74, 95% CI = 0.62–0.89). Hazard ratios among patients with PD-L1 expression of 1% to 49% and ≥ 50% were 0.56 (95% CI = 0.42–0.73) and 0.40 (95% CI = 0.28–0.56), respectively. No significant overall survival benefit with neoadjuvant chemoimmunotherapy was observed among patients with PD-L1 expression of < 1% (HR = 0.89, 95% CI = 0.66–1.19). Significant benefits were observed among patients with PD-L1 expression of 1% to 49% (HR = 0.56, 95% CI = 0.42–0.73) and ≥ 50% (HR = 0.40, 95% CI = 0.28–0.56), respectively.
No significant differences between treatments were observed in the risk for grade 3 to 4 adverse events, grade 5 adverse events, any-grade treatment-related adverse events, or surgical adverse events.
The investigators concluded: “This study found that neoadjuvant chemoimmunotherapy was superior to neoadjuvant chemotherapy across surgical, pathological, and efficacy outcomes. These findings suggest that patients with resectable NSCLC with tumor PD-L1 levels less than 1% may have an event-free survival benefit with neoadjuvant chemoimmunotherapy.”
Jonathan D. Spicer, MD, PhD, of the Department of Surgery, McGill University, Montreal, is the corresponding author of the JAMA Oncology article.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
