Neoadjuvant Chemoimmunotherapy for NSCLC: A Systematic Review and Meta-Analysis.

Autor:	Sorin M; Rosalind and Morris Goodman Cancer Institute, McGill University, Montréal, Quebec, Canada.; Department of Human Genetics, McGill University, Montréal, Quebec, Canada.; Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada., Prosty C; Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada., Ghaleb L; Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada., Nie K; Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada., Katergi K; Faculty of Medicine, University of Montreal, Montréal, Quebec, Canada., Shahzad MH; Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada., Dubé LR; Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada., Atallah A; Rosalind and Morris Goodman Cancer Institute, McGill University, Montréal, Quebec, Canada.; Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada., Swaby A; Rosalind and Morris Goodman Cancer Institute, McGill University, Montréal, Quebec, Canada.; Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada., Dankner M; Rosalind and Morris Goodman Cancer Institute, McGill University, Montréal, Quebec, Canada.; Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada., Crump T; Department of Surgery, McGill University, Montréal, Quebec, Canada., Walsh LA; Rosalind and Morris Goodman Cancer Institute, McGill University, Montréal, Quebec, Canada.; Department of Human Genetics, McGill University, Montréal, Quebec, Canada., Fiset PO; Department of Pathology, McGill University, Montréal, Quebec, Canada., Sepesi B; Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas., Forde PM; Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University, Baltimore, Maryland., Cascone T; Department of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas., Provencio M; Department of Medical Oncology, Puerta de Hierro University Hospital, Autonomous University, Madrid, Instituto de Investigacion Sanitaria Puerta de Hierro-Segovia de Arana, Spain., Spicer JD; Rosalind and Morris Goodman Cancer Institute, McGill University, Montréal, Quebec, Canada.; Department of Surgery, McGill University, Montréal, Quebec, Canada.
Jazyk:	angličtina
Zdroj:	JAMA oncology [JAMA Oncol] 2024 May 01; Vol. 10 (5), pp. 621-633.
DOI:	10.1001/jamaoncol.2024.0057
Abstrakt:	Importance: To date, no meta-analyses have comprehensively assessed the association of neoadjuvant chemoimmunotherapy with clinical outcomes in non-small cell lung cancer (NSCLC) in randomized and nonrandomized settings. In addition, there exists controversy concerning the efficacy of neoadjuvant chemoimmunotherapy for patients with NSCLC with programmed cell death 1 ligand 1 (PD-L1) levels less than 1%. Objective: To compare neoadjuvant chemoimmunotherapy with chemotherapy by adverse events and surgical, pathological, and efficacy outcomes using recently published randomized clinical trials and nonrandomized trials. Data Sources: MEDLINE and Embase were systematically searched from January 1, 2013, to October 25, 2023, for all clinical trials of neoadjuvant chemoimmunotherapy and chemotherapy that included at least 10 patients. Study Selection: Observational studies and trials reporting the use of neoadjuvant radiotherapy, including chemoradiotherapy, molecular targeted therapy, or immunotherapy monotherapy, were excluded. Main Outcomes and Measures: Surgical, pathological, and efficacy end points and adverse events were pooled using a random-effects meta-analysis. Results: Among 43 eligible trials comprising 5431 patients (4020 males [74.0%]; median age range, 55-70 years), there were 8 randomized clinical trials with 3387 patients. For randomized clinical trials, pooled overall survival (hazard ratio, 0.65; 95% CI, 0.54-0.79; I2 = 0%), event-free survival (hazard ratio, 0.59; 95% CI, 0.52-0.67; I2 = 14.9%), major pathological response (risk ratio, 3.42; 95% CI, 2.83-4.15; I2 = 31.2%), and complete pathological response (risk ratio, 5.52; 95% CI, 4.25-7.15; I2 = 27.4%) favored neoadjuvant chemoimmunotherapy over neoadjuvant chemotherapy. For patients with baseline tumor PD-L1 levels less than 1%, there was a significant benefit in event-free survival for neoadjuvant chemoimmunotherapy compared with chemotherapy (hazard ratio, 0.74; 95% CI, 0.62-0.89; I2 = 0%). Conclusion and Relevance: This study found that neoadjuvant chemoimmunotherapy was superior to neoadjuvant chemotherapy across surgical, pathological, and efficacy outcomes. These findings suggest that patients with resectable NSCLC with tumor PD-L1 levels less than 1% may have an event-free survival benefit with neoadjuvant chemoimmunotherapy.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu