Abstract 139P
Background
Several randomized clinical trials (RCTs) of perioperative immunotherapy for resectable non small cell lung cancer (NSCLC) have reported positive results. They were designed to adjuvant, neoadjuvant and sandwich (neoadjuvant plus adjuvant) immunotherapy by use of immune checkpoint inhibitors and platinum based chemotherapy (CT). The differences between neoadjuvant and sandwich modalities were unclear.
Methods
We performed a systematic review and Bayesian network meta-analysis by retrieving relevant literature from PubMed, EMBASE, Cochrane Library, Web of Science, ClinicalTrials.gov, WHO ICTRP and major international conferences. We included public data of RCTs comparing perioperative immunotherapy plus CT with CT for patients with resectable NSCLC.
Results
We analyzed 8 studies involving 3429 patients, including 6 neoadjuvant plus adjuvant (Neo-Adj) and 2 neoadjuvant (Neo) trials. For patients without programmed death-ligand 1 (PD-L1) selection, Neo-Adj had better event free survival (EFS) (hazard ratio [HR] = 0.57, 95% confidence interval [CI]: 0.40-0.77) than CT. Especially, there existed no marked difference between Neo-Adj and Neo in EFS (HR = 0.88, 95% CI: 0.48-1.68) and OS (HR = 1.02, 95% CI: 0.30-2.96). 3 treatments did not have statistical difference in the occurrence of adverse events (AEs), but Neo seemed to have lower incidence rates of any-grade AEs (odds ratio [OR] = 0.55, 95% CI: 0.17-2.32) and grade ≥ 3 AEs (OR = 0.88, 95% CI: 0.50-1.69). Subgroup analysis by PD-L1 suggested that EFS of Neo-Adj (HR = 0.42, 95% CI: 0.21-0.74) and Neo (HR = 0.24, 95% CI: 0.06-0.99) was significantly longer than CT for PD-L1 ≥ 50% subgroup. Neo-Adj had an opposite tendency in EFS than Neo when PD-L1 < 1% (HR = 0.85, 95% CI: 0.43-1.66) and PD-L1 ≥ 50% (HR = 1.76, 95% CI: 0.36-7.85).
Conclusions
Our results suggest that Neo-Adj and Neo are associated with similar EFS benefit than CT for patients with resectable NSCLC. Neo-Adj tend to cause better EFS than Neo without any PD-L1 selection. However, patients with different PD-L1 expression may obtain different benefit from Neo-Adj or Neo. Moreover, the addition of adjuvant immunotherapy to Neo have a latent risk to increase the toxicity for patients.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding
Disclosure
All authors have declared no conflicts of interest.