Department of Oncology, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, China.
Department of Pancreatic-Biliary Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, China.
Cancer Immunol Immunother. 2024 Oct 9;73(12):262. doi: 10.1007/s00262-024-03844-w.
Several trials of perioperative immunotherapy for resectable non-small cell lung cancer (NSCLC) reported positive results. They were designed to adjuvant, neoadjuvant and sandwich (neoadjuvant plus adjuvant) immunotherapy with immune checkpoint inhibitors and chemotherapy (CT). The differences between neoadjuvant and sandwich modalities were unclear.
We performed a systematic review and Bayesian network meta-analysis by retrieving relevant literature from PubMed, EMBASE, Cochrane Library, Web of Science, ClinicalTrials.gov, WHO ICTRP and major international conferences.
We analyzed 8 studies involving 3429 patients, including 6 neoadjuvant plus adjuvant (Neo-Adj) and 2 neoadjuvant (Neo) trials. Neo-Adj had better event-free survival (EFS) (hazard ratio [HR] = 0.57, 95% confidence interval [CI]: 0.45-0.71) than CT. There existed no difference between Neo-Adj and Neo in EFS (HR = 0.87, 95% CI: 0.53-1.46) and overall survival (OS) (HR = 1.04, 95% CI: 0.38-2.57). Neo might have lower incidence of treatment-related adverse events (TRAEs) (relative risk [RR] = 0.96, 95% CI: 0.87-1.12) than Neo-Adj. Subgroup analysis of PD-L1 ≥ 50% suggested that EFS of Neo-Adj (HR = 0.46, 95% CI: 0.27-0.76) and Neo (HR = 0.24, 95% CI: 0.06-0.89) was better than CT, and Neo-Adj potentially caused shorter EFS than Neo (HR = 1.92, 95% CI: 0.46-7.84).
Our results suggest that Neo-Adj and Neo have similar EFS for patients with PD-L1 < 1% or 1-49%. However, patients with PD-L1 ≥ 50% may obtain more EFS benefit from Neo than Neo-Adj. Neo might present a more favorable assessment than Neo-Adj when evaluating OS. Moreover, adding adjuvant immunotherapy may increase toxicity.
几项针对可切除非小细胞肺癌（NSCLC）的围手术期免疫治疗试验报告了积极的结果。这些试验旨在采用免疫检查点抑制剂和化疗（CT）进行辅助、新辅助和夹心（新辅助加辅助）免疫治疗。新辅助和夹心模式之间的区别尚不清楚。
我们通过从 PubMed、EMBASE、Cochrane 图书馆、Web of Science、ClinicalTrials.gov、世界卫生组织 ICTRP 和主要国际会议中检索相关文献，进行了系统评价和贝叶斯网络荟萃分析。
我们分析了 8 项涉及 3429 名患者的研究，其中包括 6 项新辅助加辅助（Neo-Adj）和 2 项新辅助（Neo）试验。Neo-Adj 的无事件生存（EFS）（风险比 [HR] = 0.57，95%置信区间 [CI]：0.45-0.71）优于 CT。Neo-Adj 和 Neo 在 EFS（HR = 0.87，95% CI：0.53-1.46）和总生存（OS）（HR = 1.04，95% CI：0.38-2.57）方面没有差异。与 Neo-Adj 相比，Neo 可能具有更低的治疗相关不良事件（TRAEs）发生率（相对风险 [RR] = 0.96，95% CI：0.87-1.12）。PD-L1 ≥ 50%的亚组分析表明，Neo-Adj（HR = 0.46，95% CI：0.27-0.76）和 Neo（HR = 0.24，95% CI：0.06-0.89）的 EFS 优于 CT，并且 Neo-Adj 可能导致比 Neo 更短的 EFS（HR = 1.92，95% CI：0.46-7.84）。
我们的结果表明，对于 PD-L1 < 1%或 1-49%的患者，Neo-Adj 和 Neo 的 EFS 相似。然而，PD-L1 ≥ 50%的患者可能从 Neo 中获得比 Neo-Adj 更多的 EFS 获益。在评估 OS 时，Neo 可能比 Neo-Adj 表现出更有利的评估。此外，添加辅助免疫治疗可能会增加毒性。
