Abstract 114P
Background
This study conducts a pooled analysis of efficacy data derived from randomized controlled trials (RCTs) investigating the addition of Anti-PD-1 or Anti-PD-L1 agents (ICI) to platinum-based chemotherapy in perioperative/neoadjuvant systemic therapy for resectable non-small cell lung cancer (NSCLC), focusing on specific subgroup efficacy outcomes.
Methods
To identify RCTs exploring the efficacy of perioperative or neoadjuvant ICI in resectable NSCLC, databases such as PUBMED, Cochrane, EMBASE, as well as studies presented at ASCO and ESMO congresses until November 15, 2023, were screened. Pooled analyses for pCR and EFS were performed according to specific subgroups including age (<65 vs >65), sex, smoking status (current or former vs never), histology (squamous vs non-squamous), stage (II vs III), type of platinum agent used (cisplatin vs carboplatin) and PD-L1 levels (<1%, 1-49% vs >50%).
Results
Seven RCTs comprising 2,934 patients (AEGEAN, KEYNOTE-671, Neotorch, NADIM II, CheckMate-77T, CheckMate-816, and TD-FOREKNOW) were included in this analysis. The pooled analysis of these trials revealed significantly higher pCR rates in the ICI arm (22.7% vs 3.7%, OR: 7.04 [5.23-9.47]). Across all subgroup analyses based on age, smoking, sex, histology, stage, platinum agent used, and PD-L1 levels, the ICI arm consistently showed significantly higher pCR rates. A joint analysis of five trials employing perioperative ICI demonstrated significantly prolonged EFS in the ICI arm (HR: 0.57 [0.50-0.65]). Pooled subgroup analyses for EFS indicated better outcomes in the ICI arm across all subgroups except for patients who had never smoked. In the non-smoker group, although there was a trend favoring ICI, there was no statistical difference (HR: 0.82 [0.53-1.25]). Moreover, a joint analysis of two trials using neoadjuvant ICI showed superior EFS in the ICI arm (HR: 0.66 [0.48-0.89]). In all analyses, I2 was <50%.
Conclusions
The addition of ICI to platinum-based systemic therapy in the perioperative or neoadjuvant treatment of resectable NSCLC significantly improves both pCR and EFS. Subgroup analyses revealed no difference in terms of EFS only among the subgroup of patients who had never smoked.
Legal entity responsible for the study
The author.
Funding
Has not received any funding.
Disclosure
The author has declared no conflicts of interest.