Dong Junguo, Wang Qixia, Wang Runchen, Ye Kaiwen, Ye Zhiming, Lin Jiayu, Liang Hengrui, Wang Wei
Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China.
Department of Respiratory, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China.
J Thorac Dis. 2024 Oct 31;16(10):6918-6935. doi: 10.21037/jtd-23-1972. Epub 2024 Sep 24.
Neoadjuvant immunotherapy is effective in treating resectable non-small cell lung cancer (NSCLC) but shows different responses in lung squamous cell carcinoma (SCC) and adenocarcinoma (ADC). Current studies are limited in size, necessitating further research to clarify these differences. This study aims to investigate whether there is a difference between the efficacy of neoadjuvant immune checkpoint inhibitors (ICIs) on lung SCC ADC.
Studies provided data of pathological or radiological response of ADC and SCC receiving neoadjuvant ICIs published before August 1, 2023, were retrieved. Pathological response included major pathological response (MPR), complete pathological response (cPR) and the sum of major pathological response and complete pathological response (McPR). Radiological response includes complete response (CR), partial response (PR), stable disease (SD), progressive disease (PD), objective response rate (ORR), disease control rate (DCR). The protocol was registered in the Prospective Register of Systematic Reviews (PROSPERO CRD42022328240).
A total of 22 studies with 430 patients were included. Pathological response and radiological response were used to evaluate the efficacy of neoadjuvant immunotherapy on ADC and SCC. No significant difference was found in pathological response (MPR: P=0.15; cPR: P=0.61), while SCC had significantly higher ORR (P=0.02), lower SD (P<0.04) and PD (P=0.04) than ADC after neoadjuvant ICIs. Both SCC and ADC achieved significantly higher PR (P<0.01), ORR (P<0.01), and lower SD (P<0.01) when treated with chemo-immunotherapy compared to ICI monotherapy. Chemo-immunotherapy significantly improved the McPR in ADC (P<0.05). Toripalimab showed a higher ORR for both SCC and ADC (P<0.05) without a clear advantage in pathological remission across the ICIs. Pembrolizumab had significantly higher McPR (P<0.05) for treating SCC patients compare to ADC patients.
In conclusion, our findings indicate that SCC patients exhibited higher ORR and lower SD and PD than those with ADC. No significant differences in pathological responses were seen between SCC and ADC, across ICI monotherapy or chemo-immunotherapy. Chemo-immunotherapy notably improved McPR in ADC. Toripalimab showed higher ORR in both cancers without distinct pathological remission advantage. Pembrolizumab, however, demonstrated superior McPR in SCC, indicating a preference in treating SCC.
新辅助免疫疗法在治疗可切除的非小细胞肺癌（NSCLC）方面有效，但在肺鳞状细胞癌（SCC）和腺癌（ADC）中表现出不同的反应。目前的研究规模有限，需要进一步研究以阐明这些差异。本研究旨在探讨新辅助免疫检查点抑制剂（ICI）对肺SCC和ADC疗效之间是否存在差异。
检索2023年8月1日前发表的提供接受新辅助ICI的ADC和SCC的病理或放射学反应数据的研究。病理反应包括主要病理反应（MPR）、完全病理反应（cPR）以及主要病理反应和完全病理反应之和（McPR）。放射学反应包括完全缓解（CR）、部分缓解（PR）、疾病稳定（SD）、疾病进展（PD）、客观缓解率（ORR）、疾病控制率（DCR）。该方案已在系统评价前瞻性注册库（PROSPERO CRD42022328240）中注册。
共纳入22项研究，430例患者。采用病理反应和放射学反应评估新辅助免疫疗法对ADC和SCC的疗效。病理反应方面未发现显著差异（MPR：P = 0.15；cPR：P = 0.61），而新辅助ICI治疗后，SCC的ORR显著高于ADC（P = 0.02），SD（P < 0.04）和PD（P = 0.04）低于ADC。与ICI单药治疗相比，SCC和ADC在接受化疗免疫治疗时均实现了显著更高的PR（P < 0.01）、ORR（P < 0.01）以及更低的SD（P < 0.01）。化疗免疫疗法显著提高了ADC的McPR（P < 0.05）。托瑞帕利单抗在SCC和ADC中均显示出更高的ORR（P < 0.05），但在所有ICI中病理缓解方面无明显优势。与治疗ADC患者相比，帕博利珠单抗治疗SCC患者的McPR显著更高（P < 0.05）。
总之，我们的研究结果表明，SCC患者的ORR高于ADC患者，SD和PD低于ADC患者。在ICI单药治疗或化疗免疫治疗中，SCC和ADC之间在病理反应方面未发现显著差异。化疗免疫疗法显著提高了ADC的McPR。托瑞帕利单抗在两种癌症中均显示出更高的ORR，但在病理缓解方面无明显优势。然而，帕博利珠单抗在SCC中表现出更高的McPR，表明其在治疗SCC方面具有优势。
