Efficacy and Outcomes of Neoadjuvant Immunotherapy in Lung Cancer

A meta-analysis of 43 studies suggests that patients with resectable non–small cell lung cancer (NSCLC) and low tumor programmed cell death 1 ligand 1 (PD-L1) levels may benefit from neoadjuvant chemoimmunotherapy for event-free survival.

Lung cancer is the leading cause of cancer death globally, with NSCLC being the most common type and associated with poor outcomes. Recent FDA approvals for neoadjuvant immunotherapy treatments highlight the need for further research through a meta-analysis to compare efficacy and outcomes in different patient subgroups.

The study search strategy included studies on neoadjuvant chemoimmunotherapy and chemotherapy in patients with resectable lung cancer published since 2013. Only articles with trial-level evidence were included, while non-relevant publication types were excluded. Quality assessment and data extraction were conducted by independent reviewers, with statistical analysis performed using R software.

The study yielded 642 total and 602 unique results, with 42 publications and 6 abstracts meeting inclusion criteria. Across these studies, 1688 patients were treated with chemotherapy and 1699 with chemoimmunotherapy, with favorable outcomes for the latter in terms of overall survival and event-free survival. Neoadjuvant chemoimmunotherapy also showed benefits in terms of pathological response rates and increased likelihood of R0 resection compared with neoadjuvant chemotherapy. Additionally, patients in chemoimmunotherapy arms had a reduced risk of not undergoing surgery and progression precluding surgery, though adverse events were more common in this group.

“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,” researchers stated. 

Reference
Sorin M, Prosty C, Ghaleb L, et al. Neoadjuvant chemoimmunotherapy for NSCLC: a systematic review and meta-analysis. JAMA Oncol. 2024;10(5):621–633. doi:10.1001/jamaoncol.2024.0057