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SYSTEMATIC REVIEW article

Front. Immunol.
Sec. Cancer Immunity and Immunotherapy
Volume 15 - 2024 | doi: 10.3389/fimmu.2024.1432813
This article is part of the Research Topic Immune-Checkpoint Inhibitors and Immunometabolic Reprogramming in Cancer Immunotherapy View all 3 articles

Efficacy and Safety of Immune Checkpoint Inhibitors as Neoadjuvant Therapy in Perioperative Patients with Non-Small Cell Lung Cancer: A Network Meta-Analysis and Systematic Review Based on Randomized Controlled Trials

Provisionally accepted
Kaiqi Chen Kaiqi Chen 1Xinwei Wang Xinwei Wang 1Rui Yue Rui Yue 2Wei Chen Wei Chen 3Danping Zhu Danping Zhu 4Shikui Cui Shikui Cui 4Xijian Zhang Xijian Zhang 4JIN ZHAO JIN ZHAO 1*Tong Xiao Tong Xiao 5
  • 1 Chengdu University of Traditional Chinese Medicine, Chengdu, China
  • 2 Changhang Hospital, Chongqing, Chongqing Municipality, China
  • 3 Department of Pharmacy, Emergency General Hospital, Beijing, China
  • 4 Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
  • 5 Capital Medical University, Beijing, Beijing Municipality, China

The final, formatted version of the article will be published soon.

    Background: Presently, numerous perioperative immunotherapy regimens centered around the integration of ICIs and chemotherapy have undergone clinical trials.Nonetheless, due to the absence of direct comparative RCTs among these treatment regimens, this study aims to employ Bayesian network meta-analysis to ascertain the optimal combination of ICIs and chemotherapy.Methods: A systematic literature search was conducted in PubMed, EMBASE, Cochrane Library, Web of Science databases, and major international conference publications up to April 10, 2024. This comprehensive search yielded a total of 1434 studies. Following a rigorous screening process that involved evaluating the studies for relevance, methodological quality, and alignment with our research objectives, 8 studies were carefully selected for inclusion in the final analysis. Based on these curated search results, a systematic review and network meta-analysis were conducted.Results: 8 RCTs were included, encompassing 7 treatments and involving 3699 operable NSCLC patients at stages I-III. Compared to chemotherapy alone, perioperative immunotherapy demonstrated higher efficacy.The combination of toripalimab and chemotherapy showed the most significant improvement in event-free survival ( HR= 0.40). The regimen that most notably enhanced overall survival was Nivolumab combined with chemotherapy (HR = 0.62). In terms of pathological complete response, the combination of Toripalimab and chemotherapy exhibited the highest benefit (OR = 32.89). Regarding the improvement in R0 resection, Pembrolizumab plus chemotherapy performed most prominently(OR=2.15). In terms of the incidence of grade 3 or higher adverse events, durvalumab combined with chemotherapy had the lowest incidence (OR = 1.05), while the incidence for other regimens was higher than chemotherapy alone.The efficacy of perioperative immunotherapy plus chemotherapy in patients with early NSCLC is significantly improved compared to chemotherapy alone. Although there is a certain risk of adverse events, the safety is within a controllable range. After a comprehensive evaluation of five endpoints in this study, it is believed that the combination of Toripalimab or Nivolumab with chemotherapy may be the optimal immunotherapy regimen for the treatment of stage Ib-IIIb NSCLC. These findings will help guide the design of clinical treatment plans and ICIs selection.

    Keywords: Non-small cell lung cancer, Neoadjuvant Therapy, Perioperative Period, ICIS, efficacy and safety, Network meta-analysis

    Received: 14 May 2024; Accepted: 17 Sep 2024.

    Copyright: © 2024 Chen, Wang, Yue, Chen, Zhu, Cui, Zhang, ZHAO and Xiao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: JIN ZHAO, Chengdu University of Traditional Chinese Medicine, Chengdu, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.