Perioperative PD-1/PD-L1 inhibitors for resectable non-small cell lung cancer: A meta-analysis based on randomized controlled trials

• Published in: PloS one 2024-09, Vol.19 (9), p.e0310808
• Main Authors: Huang, Hai, Li, Lianyun, Tong, Ling, Luo, Houfu, Luo, Huijing, Zhang, Qimin
• Format: Article
• Language: English
• Subjects: Adjuvant treatment; Antigen presentation; Antimitotic agents; Antineoplastic agents; Apoptosis; B7-H1 Antigen - antagonists & inhibitors; Biology and Life Sciences; Cancer; Cancer therapies; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - pathology; Care and treatment; Chemotherapy; Clinical trials; Complications and side effects; Development and progression; Dosage and administration; Health aspects; Humans; Identification methods; Immune Checkpoint Inhibitors - adverse effects; Immune Checkpoint Inhibitors - therapeutic use; Immunotherapy; Inhibitors; Lung cancer; Lung cancer, Non-small cell; Lung cancer, Small cell; Lung diseases; Lung Neoplasms - drug therapy; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Medicine and Health Sciences; Meta-analysis; Neoadjuvant Therapy - methods; Non-small cell lung carcinoma; Oncology, Experimental; Patients; PD-1 protein; PD-L1 protein; Physical Sciences; Programmed Cell Death 1 Receptor - antagonists & inhibitors; Randomized Controlled Trials as Topic; Research and Analysis Methods; Small cell lung carcinoma; Subgroups; Surgery; Surgical outcomes; Survival
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0310808

PD-1/PD-L1 inhibitors (PI) have shown promising results in both neoadjuvant and adjuvant therapies for resectable non-small cell lung cancer (NSCLC). However, substantial evidence from large-scale studies is still lacking for their use in the perioperative setting (neoadjuvant plus adjuvant). This meta-analysis aims to evaluate the integration of perioperative PI (PPI) with neoadjuvant chemotherapy for resectable NSCLC. To identify appropriate randomized controlled trials (RCTs), we thoroughly explored six different databases. The primary endpoint was survival, while the secondary measures included pathological responses and adverse events (AEs). Six RCTs involving 2941 patients were included. The PPI group significantly improved overall survival (OS) (hazard ratio [HR]: 0.62 [0.51, 0.77]), event-free survival (EFS) (HR: 0.57 [0.51, 0.64]), pathological complete response (risk ratio [RR]: 5.81 [4.47, 7.57]), and major pathological response (RR: 2.60 [1.77, 3.82]). Benefits in EFS were seen across all subgroups. OS rates at 12-48 months and EFS rates at 6-48 months were higher in the PPI cohort. Furthermore, the advantages in OS and EFS increased with prolonged survival times. The PPI group also exhibited higher rates of surgery and R0 resections. However, the PPI group experienced more grade 3-5 AEs, serious AEs, and treatment discontinuations due to AEs. The integration of perioperative PI with neoadjuvant chemotherapy can significantly improve survival and pathological responses for resectable NSCLC. However, the increased incidence of grade 3-5 AEs must be carefully evaluated.