In:
Frontiers in Oncology, Frontiers Media SA, Vol. 14 ( 2024-2-22)
Abstract:
In recent years, we have observed the pivotal role of immunotherapy in improving survival for patients with non-small cell lung cancer (NSCLC). However, the effectiveness of immunotherapy in the perioperative (neoadjuvant + adjuvant) treatment of resectable NSCLC remains uncertain. We conducted a comprehensive analysis of its antitumor efficacy and adverse effects (AEs) by pooling data from the KEYNOTE-671, NADIM II, and AEGEAN clinical trials. Methods For eligible studies, we searched seven databases. The randomized controlled trials (RCTs) pertaining to the comparative analysis of combination neoadjuvant platinum-based chemotherapy plus perioperative immunotherapy (PIO) versus perioperative placebo (PP) were included. Primary endpoints were overall survival (OS) and event-free survival (EFS). Secondary endpoints encompassed drug responses, AEs, and surgical outcomes. Results Three RCTs (KEYNOTE-671, NADIM II, and AEGEAN) were included in the final analysis. PIO group (neoadjuvant platinum-based chemotherapy plus perioperative immunotherapy) exhibited superior efficacy in OS (hazard ratio [HR]: 0.63 [0.49-0.81] ), EFS (HR: 0.61 [0.52, 0.72]), objective response rate (risk ratio [RR] : 2.21 [1.91, 2.54]), pathological complete response (RR: 4.36 [3.04, 6.25] ), major pathological response (RR: 2.79 [2.25, 3.46]), R0 resection rate (RR: 1.13 [1.00, 1.26] ) and rate of adjuvant treatment (RR: 1.08 [1.01, 1.15]) compared with PP group (neoadjuvant platinum-based chemotherapy plus perioperative placebo). In the subgroup analysis, EFS tended to favor the PIO group in almost all subgroups. BMI ( & gt;25), T stage (IV), N stage (N1-N2) and pathological response (with pathological complete response) were favorable factors in the PIO group. In the safety assessment, the PIO group exhibited higher rates of serious AEs (28.96% vs. 23.51%) and AEs leading to treatment discontinuation (12.84% vs. 5.81%). Meanwhile, although total adverse events, grade 3-5 adverse events, and fatal adverse events tended to favor the PP group, the differences were not statistically significant. Conclusion PIO appears to be superior to PP for resectable stage II-III NSCLC, demonstrating enhanced survival and pathological responses. However, its elevated adverse event (AE) rate warrants careful consideration. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/#recordDetails , identifier CRD42023487475.
Type of Medium:
Online Resource
ISSN:
2234-943X
DOI:
10.3389/fonc.2024.1351359
DOI:
10.3389/fonc.2024.1351359.s001
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10.3389/fonc.2024.1351359.s002
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10.3389/fonc.2024.1351359.s003
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10.3389/fonc.2024.1351359.s004
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10.3389/fonc.2024.1351359.s005
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10.3389/fonc.2024.1351359.s006
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10.3389/fonc.2024.1351359.s007
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10.3389/fonc.2024.1351359.s008
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10.3389/fonc.2024.1351359.s009
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10.3389/fonc.2024.1351359.s010
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10.3389/fonc.2024.1351359.s011
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10.3389/fonc.2024.1351359.s012
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10.3389/fonc.2024.1351359.s013
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10.3389/fonc.2024.1351359.s014
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10.3389/fonc.2024.1351359.s015
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10.3389/fonc.2024.1351359.s016
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10.3389/fonc.2024.1351359.s017
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10.3389/fonc.2024.1351359.s018
DOI:
10.3389/fonc.2024.1351359.s019
DOI:
10.3389/fonc.2024.1351359.s020
Language:
Unknown
Publisher:
Frontiers Media SA
Publication Date:
2024
detail.hit.zdb_id:
2649216-7
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