In a recent publication in the Journal of the American Medical Association Oncology, researchers conducted a meta-analysis using recently published randomized clinical trials and nonrandomized trials to compare neoadjuvant chemoimmunotherapy with chemotherapy by adverse events and surgical, pathological, and efficacy outcomes.

The authors wrote, “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%.”

This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. The researchers systemically searched literature from MEDLINE and Embase between January 1, 2013, and October 25, 2023, for all clinical trials involving neoadjuvant chemoimmunotherapy and chemotherapy that included at least 10 patients.

Observational studies and trials reporting the use of neoadjuvant radiotherapy, including chemoradiotherapy, molecular targeted therapy, or immunotherapy monotherapy, were eliminated. The primary outcomes were pooled using a random-effects meta-analysis, which included surgical, pathological, and efficacy endpoints and adverse events.

Among 43 eligible trials, which included 5,431 patients (4,020 males [74.0%]; median age range, 55-70 years), there were eight randomized clinical trials that included 3,387 patients.

The authors wrote, “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%).”

Based on their findings, the authors concluded that this study discovered that across surgical, pathological, and efficacy outcomes, neoadjuvant chemoimmunotherapy was superior to neoadjuvant chemotherapy. The findings also suggest that patients with resectable NSCLC with tumor PD-L1 levels less than 1% may have an event-free survival benefit with neoadjuvant immunochemotherapy.

The authors also noted that additional studies should be conducted to evaluate whether the specific type of chemotherapy or immunotherapy is associated with outcomes for patients treated with neoadjuvant chemoimmunotherapy.

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