357P - Comparison between immunotherapy and chemotherapy as neoadjuvant setting in resectable non-small cell lung cancer: A systematic review and meta-analysis of prospective trials

Background

Programmed cell death/programmed cell death ligand 1 (PD-1/PD-L1) inhibitors have preliminarily shown encouraging results as neoadjuvant setting. No data reported on randomized trials comparing neoadjuvant immunotherapy and chemotherapy leaving undetermined critical issues for better clinical treatment options.

Methods

We conducted a systemic review of trials involving neoadjuvant immunotherapy and chemotherapy, performing an indirect comparison meta-analysis of neoadjuvant immunotherapy and neoadjuvant chemotherapy upon multiple short-term outcome.

Results

This systematic review and meta-analysis included 10 trials of neoadjuvant immunotherapy and 11 neoadjuvant chemotherapy involving 1755 patients. Patients received PD-1/PD-L1 inhibitors alone (13.3%; 95%CI, 9.0%-19.3%) had lower objective response rate (ORR) compared to PD-1/PD-L1 inhibitors plus chemotherapy (62.5%; 95%CI, 54.4%-70.0%) or chemotherapy (41.6%; 95%CI, 36.8%-46.7%) while neoadjuvant PD-1/PD-L1 inhibitors plus chemotherapy (36.2%; 95%CI, 19.2%-57.6%) achieved elevated complete pathological complete response (pCR) eclipsing PD-1/PD-L1 inhibitors alone (10.6%; 95%CI, 6.5%-16.9%) and standard chemotherapy (7.5%; 95%CI, 5.7%-9.8%). Neoadjuvant chemotherapy (87.2%; 95%CI, 74.9%-94.0%) has numerically lower R0 resection rate in contrast to neoadjuvant PD-1/PD-L1 inhibitors alone (92.7%; 95%CI, 83.4%-97.0%) and PD-1/PD-L1 inhibitors plus chemotherapy (91.6%; 95%CI, 84.3%-95.7%). Subgroup analysis showed that increased proportion of stage III patients receiving neoadjuvant chemotherapy (p=0.025, Spearman r=0.761) may be correlated with lower R0 resection rate while no significant correlation was found in PD-1/PD-L1-based neoadjuvant treatment.

Conclusions

Compared to neoadjuvant chemotherapy, immunotherapy-based regimens provided superior pathological response along with higher complete resection rate especially for stage III disease. Immunotherapy combined chemotherapy as neoadjuvant setting may be a more preferable clinical option currently.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Wen-zhao Zhong.

Funding

National Natural Science Foundation.

Disclosure

All authors have declared no conflicts of interest.