1245P - Efficacy and safety of neoadjuvant immunotherapy plus chemotherapy vs. neoadjuvant chemotherapy in lung cancer treatment: A mixed method meta-analysis based on global randomized controlled trials

Background

Immunotherapy and chemotherapy combo as neoadjuvant therapy for lung cancer is gaining attention. However, limited direct evidence on its efficacy and safety compared to chemotherapy alone. This study aims to comprehensively assess their combined efficacy and safety, as well as explore variations among immunotherapeutic agents.

Methods

This study collected data on efficacy and safety outcomes of phase II and III global randomized controlled trials comparing neoadjuvant immunotherapy plus chemotherapy vs. neoadjuvant chemotherapy in lung cancer treatment from databases. A meta-analysis and frequentist network meta-analysis were conducted using a random effects model, with results reported as RR or HR and 95% CI. Bias risk was assessed using the Cochrane tool, while AMSTAR2, GRADE, and Evidence Class methods evaluated evidence quality.

Results

The study analysed eight trials with a total of 2567 participants. The meta-analysis results indicated that combining neoadjuvant immunotherapy with chemotherapy was more effective than using neoadjuvant chemotherapy alone to improve event-free survival (EFS) in NSCLC patients (median EFS HR 0.57, 95% CI 0.48-0.67, I2=24%, p=2.2e-11). The combined therapy approach also increased the likelihood of surgical acceptance and R0 resection. Patients receiving this combined therapy had significantly higher rates of pathological complete response (pCR) and major pathological response (MPR) (RR 4.03, 95% CI 2.90-5.88 and RR 3.83, 95% CI 2.54-5.77, respectively), with no significant differences in safety. Network meta-analysis further confirmed the benefits of neoadjuvant immunotherapy using different drugs, and all studies had low risk of bias and moderate-to-high evidence quality. Sensitivity analysis supported the robustness of the results.

Conclusions

Neoadjuvant immunotherapy plus chemotherapy provides better survival benefits for NSCLC patients with acceptable safety. Its potential in clinical practice is clear. Broader attention and use is warranted, with continued research to optimize outcomes and improve patients’ survival and quality of life.

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.