Abstract 118P
Background
A previous metanalysis showed no significant subgroup interaction between PD-L1 and pCR, while both PD-L1 status and pCR significantly correlated with better event free survival (EFS). Overall, no difference in EFS between NEO and PERIOP strategies was reported by indirect comparison (Nuccio et al). Additional RCTs and updated results of previous studies could help to define the role of PD-L1 and pCR and the best treatment strategy according to these variables.
Methods
PubMed, Embase and Cochrane were searched until 11/2023 for RCTs comparing NEO or PERIOP ICI + PCT with NEO PCT in patients (pts) with resectable NSCLC. Association between PD-L1 tumor proportional score (TPS) and pCR and correlation between PD-L1, pCR and EFS was assessed. Indirect comparison between PERIOP and NEO strategies was performed in PD-L1 and pCR subgroups.
Results
8 RCTs (n=3407) were included. PERIOP/NEO significantly improved both pCR (χ2 = 10.45, p < 0.00001, I2= 33%) and EFS (χ2 = 6.33, p < 0.00001, I2= 5%).There was a significant subgroup interaction for pCR by PD-L1 TPS (<1%, 1-49% and ≥50%: χ2 = 6.44, p = 0.04, I2=68.9%). EFS significantly correlated with PD-L1 status (TPS <1% vs 1-49% vs ≥50%: χ2 = 13.28, p = 0.001, I2=84.9%) and pCR (χ2 =18.96, p < 0.0001, I2=94.7%). No difference in EFS between PERIOP and NEO strategies was observed either according to PDL1 status [TPS <1%: HR 1.03 (95% CI 0.68-1.56); 1-49%: HR 1.85 (95% CI 0.96-3.58); ≥50%: HR 1.54 (95% CI 0.77-3.05)] or according to pCR [pCR: HR 2.36 (95% CI 0.72-7.68); no-pCR: HR 0.86; (95% CI 0.60-1.23)].
Table: 118P
| pCR (RR) | χ2 | p value | EFS (HR) | χ2 | p value | ||
| Overall | 5.65 [4.09, 7.82] | 10.45 | < 0.00001 | 0.59[0.52, 0.67] | 6.33 | < 0.00001 | |
| Pathological response | no-pCR | Not applicable | 0.75 [0.64, 0.87] | 18.96 | < 0.0001 | ||
| pCR | 0.19 [0.11, 0.35] | ||||||
| PD-L1 | <1% | 3.70 [2.41, 5.71] | 6.44 | 0.04 | 0.75 [0.62, 0.91 | 4.2 | 0.04 |
| 1-49% | 5.42 [2.66, 11.04] | 0.56 [0.42, 0.75] | |||||
| ≥50% | 8.25 [5.30, 12.83] | 0.38 [0.28, 0.56] |
Conclusions
Updated results of previous studies and additional RCTs showed that PD-L1 status significantly correlates both with pCR and EFS and confirmed the achievement of pCR as a predictor of EFS benefit. NEO and PERIOP are equivalent strategies in all different PD-L1 and pCR categories.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
A. Bulotta: Financial Interests, Personal, Expert Testimony: Roche; Financial Interests, Personal, Invited Speaker: BMS, MSD, AstraZeneca, Eli Lilly. T. Cascone: Financial Interests, Personal, Invited Speaker: BMS, Medscape, IDEOlogy Health, PER, OncLive, PeerView and Clinical Care Optrions, SITC; Financial Interests, Personal, Expert Testimony: AstraZeneca, Merk, Pfizer. M.C. Garassino: Financial Interests, Personal, Invited Speaker: AstraZeneca, Abion, MSD, Bayer, Boehringer Ingelheim Italia, Eli Lilly, Incyte, Novartis, Pfizer, Roche, Takeda, Seattle Genetics, Mirati, Daiichi Sankyo, Regeneron, Merk, Blueprint, Janssen, Sanofi, AbbVie, Medscape, Oncohost, BeiGeneius. G. Veronesi: Financial Interests, Personal, Invited Speaker: Ab Medica, Roche, AstraZeneca, MSD. R. Ferrara: Financial Interests, Personal, Advisory Board: MSD, BeiGene. All other authors have declared no conflicts of interest.