A Comprehensive Study on Clinical Outcomes and Safety of Neoadjuvant Immunotherapy Combined With Chemotherapy in Limited-Stage Small Cell Lung Cancer.

Abstract

Background: This study aims to explore clinical outcomes and safety of neoadjuvant immunotherapy combined with chemotherapy in limited-stage small cell lung cancer (SCLC), providing insights for upcoming clinical trials.

Methods: PubMed, Embase, Cochrane Library, and ClinicalTrials.gov databases were searched for relevant original articles and conference proceedings, updated through 10 February 2025. Pathological complete response (pCR) rate and major pathological response (MPR) rate were calculated as the major assessments for the clinical outcomes. The incidences of the rate of R0 resection and treatment-related severe adverse events (tr-SAE) were considered as the primary outcomes for assessing the safety. Subgroup analyses were conducted according to neoadjuvant therapy cycle and study type.

Results: A total of 114 patients from 6 studies were included. The meta-analysis results suggested that the pooled rates of pCR and MPR were 35% [95% confidence interval (CI) 14-56] and 49% (95% CI 18-80) in LS-SCLC patients. In terms of safety, most patients achieved R0 surgical resection [95% (95% CI 85-100)] and the pooled incidence of tr-SAE was 44% (95% CI 13-76). Meanwhile, all studies reported that there were no deaths during the perioperative period. Subgroup analysis suggests that more than two neoadjuvant therapy cycles may be associated with better clinical outcomes.

Conclusions: In conclusion, the current research findings demonstrate that neoadjuvant immunotherapy has shown promising clinical efficacy and acceptable safety in SCLC. These results provide valuable reference for upcoming clinical trials regarding the optimal neoadjuvant strategy and potential beneficiary populations.