Efficacy and Safety of Neoadjuvant Immunotherapy plus Chemotherapy versus Neoadjuvant Chemotherapy in Non-Small Cell Lung Cancer Treatment: A Mixed Method Meta-Analysis Based on Global Randomized Controlled Trials

Abstract

This study explores the efficacy and safety of combining immunotherapy with chemotherapy for neoadjuvant non-small cell lung cancer (NSCLC) treatment. Despite the rapid advancement of immunotherapy, direct evidence comparing it with chemotherapy alone is limited. Following PRISMA guidelines, we analyzed global phase II and III randomized controlled trials data. Our meta-analysis included nine trials with 3431 participants, showing that combined treatment significantly improved event-free survival, pathological complete response, major pathological response, surgical acceptance, and R0 resection rates in NSCLC compared with chemotherapy alone. Safety analysis revealed similar all adverse event incidences between treatments, while Grade ≥3 adverse events were higher than those in neoadjuvant chemotherapy. Network meta-analysis confirmed the benefits of different immunotherapeutic drugs and efficacy in different subgroups. The study's high-quality evidence suggests that neoadjuvant immunotherapy plus chemotherapy should be considered in clinical practice for NSCLC, with further research needed to optimize treatment strategies and improve patient outcomes.