Girard Nicolas, Besada Mariam, Rogula Basia, Lucherini Stefano, Vo Lien, Chaudhary Mohammad A, Goring Sarah, Lozano-Ortega Greta, Tran Mia, Varol Nebibe, Waser Nathalie, Yu Winifred W, Lee Jay M, Spicer Jonathan
Department of Medical Oncology, Institut Curie, 75005 Paris, France.
Paris Saclay University, University of Versailles Saint-Quentin-en-Yvelines (UVSQ), 78000 Versailles, France.
Cancers (Basel). 2024 Jul 8;16(13):2492. doi: 10.3390/cancers16132492.
This study aimed to estimate the relative efficacy of neoadjuvant nivolumab in combination with chemotherapy (neoNIVO + CT) compared to relevant treatments amongst resectable non-metastatic non-small-cell lung cancer (rNSCLC) patients.
Treatment comparisons were based on a network meta-analysis (NMA) using randomized clinical trial data identified via systematic literature review (SLR). The outcomes of interest were event-free survival (EFS) and pathological complete response (pCR). NeoNIVO + CT was compared to neoadjuvant chemotherapy (neoCT), neoadjuvant chemoradiotherapy (neoCRT), adjuvant chemotherapy (adjCT), and surgery alone (S). Due to the potential for effect modification by stage, all-stage and stage-specific networks were considered. Fixed-effect (FE) and random-effects Bayesian NMA models were run (EFS = hazard ratios [HR]; pCR = odds ratios [OR]; 95% credible intervals [CrI]).
Sixty-one RCTs were identified (base case = 9 RCTs [ = 1978 patients]). In the all-stages FE model, neoNIVO + CT had statistically significant EFS improvements relative to neoCT (HR = 0.68 [95% CrI: 0.49, 0.94]), S (0.59 [0.42, 0.82]), adjCT (0.66 [0.45, 0.96]), but not relative to neoCRT (HR = 0.77 [0.52, 1.16]). NeoNIVO + CT (5 RCTs) had statistically significant higher odds of pCR relative to neoCT (OR = 12.53 [5.60, 33.82]) and neoCRT (7.15 [2.31, 24.34]). Stage-specific model findings were consistent.
This NMA signals improved EFS and/or pCR of neoNIVO + CT relative to comparators among patients with rNSCLC.
本研究旨在评估新辅助纳武利尤单抗联合化疗（neoNIVO + CT）与可切除的非转移性非小细胞肺癌（rNSCLC）患者的相关治疗相比的相对疗效。
治疗比较基于网络荟萃分析（NMA），使用通过系统文献综述（SLR）确定的随机临床试验数据。感兴趣的结局是无事件生存期（EFS）和病理完全缓解（pCR）。将neoNIVO + CT与新辅助化疗（neoCT）、新辅助放化疗（neoCRT）、辅助化疗（adjCT）和单纯手术（S）进行比较。由于分期可能存在效应修饰，因此考虑了全阶段和特定阶段的网络。运行固定效应（FE）和随机效应贝叶斯NMA模型（EFS = 风险比[HR]；pCR = 比值比[OR]；95%可信区间[CrI]）。
共识别出61项随机对照试验（基础病例 = 9项随机对照试验[ = 1978例患者]）。在全阶段FE模型中，相对于neoCT（HR = 0.68 [95% CrI：0.49，0.94]）、S（0.59 [0.42，0.82]）、adjCT（0.66 [0.45，0.96]），neoNIVO + CT在EFS方面有统计学显著改善，但相对于neoCRT（HR = 0.77 [0.52，1.16]）无显著改善。相对于neoCT（OR = 12.53 [5.60，33.82]）和neoCRT（7.15 [2.31，24.34]），neoNIVO + CT（5项随机对照试验）的pCR几率有统计学显著提高。特定阶段模型的结果一致。
该网络荟萃分析表明，相对于rNSCLC患者的对照治疗，neoNIVO + CT的EFS和/或pCR有所改善。
