Improved event-free survival after complete or major pathologic response in patients with resectable NSCLC treated with neoadjuvant chemoimmunotherapy regardless of adjuvant treatment: a systematic review and individual patient data meta-analysis
Abstract
BACKGROUND
Neoadjuvant chemoimmunotherapy has reshaped the treatment landscape for resectable NSCLC, yet the prognostic significance of pathologic response remains unclear. We conducted a systematic review and individual patient data (IPD) meta-analysis to evaluate the impact of achieving pCR or MPR on EFS and assessed the influence of adjuvant immunotherapy.
METHODS
We performed an IPD meta-analysis of prospective clinical trials on neoadjuvant or perioperative anti-PD-(L)1 in combination with platinum-based chemotherapy in patients with resectable NSCLC. IPD was extracted from Kaplan-Meier curves for pCR and/or MPR from the included studies. Survival outcomes were compared between patients achieving pCR or MPR and those who did not, considering both intention-to-treat (ITT) and resected populations.
RESULTS
Achieving pCR or MPR was associated with improved EFS in the ITT population (pCR, HR 0.13; MPR, HR 0.18, respectively) with a 24 months EFS rate of 94% and 88% for patients who achieved pCR and MPR, respectively. Independently from pCR status, patients who were treated in an experimental arm that included adjuvant immunotherapy had similar EFS.
CONCLUSION
Our study showed a strong EFS improvement in patients who achieved either pCR or MPR after neoadjuvant chemoimmunotherapy. The use of adjuvant immunotherapy after tumour resection was not associated with improved EFS.
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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