Neoadjuvant Chemoimmunotherapy Shows Superiority in Non–Small Cell Lung Cancer Treatment

A new meta-analysis on neoadjuvant therapy for non–small cell lung cancer (NSCLC) has unveiled findings indicating that neoadjuvant chemoimmunotherapy holds superiority over traditional chemotherapy across multiple key metrics.

In the realm of NSCLC treatment, the integration of neoadjuvant therapies has long been a subject of extensive research and debate. Recently, a study published in JAMA Oncology has shed new light on this matter, offering comprehensive insights into the efficacy and safety of neoadjuvant chemoimmunotherapy compared with traditional chemotherapy in patients with NSCLC. The study, which systematically analyzed both randomized clinical trials and nonrandomized trials, aimed to examine the optimal preoperative treatment strategies for NSCLC.

Until now, published research lacked a thorough examination of the association between neoadjuvant chemoimmunotherapy and clinical outcomes in NSCLC across various trial settings. Addressing this gap, the study researchers compared the adverse events and surgical, pathological, and efficacy outcomes associated with neoadjuvant chemoimmunotherapy vs chemotherapy, particularly focusing on patients with PD-L1 levels less than 1%.

Drawing from a search of MEDLINE and Embase databases spanning from January 2013 to October 2023, the meta-analysis encompassed 43 eligible trials involving 5431 patients, 4020 of whom were male (74.0%), and a median age range of 55 to 70 years. Among these trials, 8 were randomized clinical trials, revealing data favoring neoadjuvant chemoimmunotherapy over neoadjuvant chemotherapy.

Pooled overall survival demonstrated an HR of 0.65 (95% CI, 0.54-0.79; I² = 0%), indicating a significant advantage for chemoimmunotherapy. Similarly, event-free survival exhibited a HR of 0.59 (95% CI, 0.52-0.67; I² = 14.9%), further supporting the superiority of chemoimmunotherapy over chemotherapy.

In terms of pathological responses, neoadjuvant chemoimmunotherapy showed remarkable efficacy. Major pathological response displayed a risk ratio of 3.42 (95% CI, 2.83-4.15; I² = 31.2%), while complete pathological response exhibited a risk ratio of 5.52 (95% CI, 4.25-7.15; I² = 27.4%). These findings indicate the effectiveness of chemoimmunotherapy in inducing significant pathological responses compared with chemotherapy.

For patients with baseline tumor PD-L1 levels less than 1%, there was a notable benefit in event-free survival associated with neoadjuvant chemoimmunotherapy. The HR stood at 0.74 (95% CI, 0.62-0.89; I² = 0%), further highlighting the therapeutic advantage of chemoimmunotherapy in this specific subgroup.

The findings show that not only is neoadjuvant chemoimmunotherapy a superior treatment option in NSCLC across various clinical end points, but it also offers a potential breakthrough for patients with lower PD-L1 expression levels, a group previously deemed less responsive to immunotherapy, investigators noted.

This meta-analysis underscores the importance of integrating immunotherapy into the neoadjuvant treatment paradigm for NSCLC. The findings not only affirm the efficacy of chemoimmunotherapy but also highlight its potential to redefine treatment standards and improve outcomes for a broader spectrum of NSCLC patients. As research in this field continues to evolve, these insights pave the way for more personalized and effective therapeutic approaches in the fight against NSCLC.

Reference

Sorin M, Prosty C, Ghaleb L, et al. Neoadjuvant chemoimmunotherapy for NSCLC: a systematic review and meta-analysis. JAMA Oncol. Published online March 21, 2024. doi:10.1001/jamaoncol.2024.0057