Abstract 1288P
Background
Neoadjuvant chemotherapy (CT) has limited benefit over surgery alone for resectable non-small cell lung cancer (NSCLC). Recent trials have shown promising results for combining immune checkpoint inhibitors with platinum-doublet chemotherapy (ICI plus CT).
Methods
We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) that compared neoadjuvant ICI plus CT versus CT alone in patients with resectable NSCLC. We searched PubMed, Scopus, and Cochrane Library databases, as well as the ASCO, ESMO, and AACR websites. We used a fixed effects model for analysis and assessed heterogeneity with I2 statistics.
Results
We included six RCTs with 2,471 patients, of whom 75% were male, 47% had non-squamous, and 53% had squamous cell carcinoma (SCC). The median age was 63.3 years (ranged from 29 to 88). After neoadjuvant therapy, 84% of patients in the ICI plus CT group underwent surgery compared to 81% in the CT group (p=0.16); R0 resection was reported in 78% versus 67% of patients (p<0.01), respectively. We found a significantly higher pathologic complete response (risk ratio [RR] 5.81 [95%CI 4.26-7.92]) and major pathologic response (RR 3.57 [3.09-4.55]) in patients who received ICI plus CT than those in the CT group. Treatment with ICI plus CT provided a greater benefit of event-free survival (EFS) (HR 0.59 95%CI 0.51-0.67 p<0.00001) and overall survival (HR 0.66 95%CI 0.53-0.82 p=0.0002)compared to CT alone. ICI plus CT improved EFS regardless of PD-L1 expression, type of platinum CT, or histology. Patients with PD-L1 ≥1% achieved considerably better EFS than those with PD-L1 <1% (HR 0.40 vs 0.76, p<0.0001). Subgroup analysis showed EFS benefit for all stages (IB and II, IIIA, and IIIB). Treatment-related adverse events grades 3 or 4 were seen in 36% of patients in the intervention arm and 32% of the control arm (p=0.05).
Conclusions
Neoadjuvant therapy with anti-PD-1/PD-L1 plus CT provided significantly higher pathologic response, EFS, and OS compared to CT alone for resectable stage II-III NSCLC patients. More mature data from the trials are awaited to confirm these findings.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
Resources from the same session
1265P - Toripalimab plus chemotherapy as neoadjuvant treatment for resectable stage IIB-IIIB NSCLC (RENAISSANCE study): A single-arm, phase II trial
Presenter: Shi Yan
Session: Poster session 04
1266P - Prediction of lung cancer risk in ground-glass nodules using deep learning from CT images
Presenter: Anil Vachani
Session: Poster session 04
1267P - Enhancing pulmonary nodule diagnosis: A combinatorial model of cfDNA methylation, plasma proteins and LDCT imaging
Presenter: Meng Yang
Session: Poster session 04
1268P - Liquid biopsy and CT-based multi-omics fusion enhances differential diagnosis of early-stage lung adenocarcinoma
Presenter: Yanwei Zhang
Session: Poster session 04
1269P - Machine learning model for predicting lung cancer recurrence after surgical treatment: A retrospective study using NLST and European hospital data
Presenter: Ann Valter
Session: Poster session 04
1272P - Postoperative survival prediction in non-small cell lung cancer patients based on driver genotypes
Presenter: Huiting Wang
Session: Poster session 04
1273P - The prognostic value evaluation of a tissue Comprehensive Genomic Profiling (CGP)-informed personalized MRD detection assay in NSCLC
Presenter: Wei Gao
Session: Poster session 04
1274P - Early dynamics of circulating tumor DNA following curative hypofractionated radiotherapy related to disease control in lung cancer
Presenter: Kyungmi Yang
Session: Poster session 04
1275P - Genomic analysis of lung adenocarcinoma with micropapillary component: Identification of micropapillary-related subtypes and development of a prognostic model
Presenter: Yuechun Lin
Session: Poster session 04