Ben Ponvilawan , Himil Mahadevia , Hana Qasim , Parth Sharma , Dhruv Bansal , Janakiraman Subramanian
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引用次数: 0
摘要
最近的随机对照试验（RCT）表明，使用免疫检查点抑制剂（ICIs）和化疗进行新辅助或辅助治疗可改善可切除非小细胞肺癌（NSCLC）患者的生存预后。我们对RCT进行了这项荟萃分析，以根据临床特征和治疗顺序确定生存获益。我们从 CENTRAL、Embase 和 Medline 数据库中找到了所有涉及可切除 NSCLC 患者的 II 期或 III 期 RCT，这些 RCT 报告了总生存期 (OS)、无事件生存期 (EFS)、无病生存期 (DFS) 或病理完全缓解。一个研究组必须接受 ICI（s）联合或不联合化疗（CTX）；另一个研究组必须单独接受 CTX 作为新辅助治疗、辅助治疗或围手术期治疗。将每项研究的效应估计值和 95% 置信区间 (CI) 合并，使用通用逆方差法确定汇总的危险比 (HR)。荟萃分析共纳入了 11 项研究。新辅助或围手术期 ICI 治疗可显著改善 OS（集合 HR 0.66，95% CI 0.55-0.79）和 EFS（HR 0.59，95% CI 0.53-0.67）。辅助 ICI 方案能显著改善 DFS，但不能改善 OS（集合 HR 分别为 0.77，95% CI 0.67 - 0.89 和 0.94，95% CI 0.78 - 1.12）。在PD-L1状态阳性和疾病处于III期的患者中，围手术期和新辅助ICI的EFS趋势良好。与单独使用CTX相比，使用CTX和ICI进行新辅助治疗和围手术期治疗可提高可切除NSCLC患者的生存率。要确定这类患者的最佳治疗时间，还需要进一步的研究。
Brief Report: Evaluating the Impact of Perioperative Immune Checkpoint Inhibitor in the Treatment of Patients with Resectable Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis
•
Resectable NSCLC has a high recurrence rate of 30-55%. Neoadjuvant, adjuvant, or perioperative combination of ICIs and CTX improved survival outcomes and response rates compared to CTX alone. Our meta-analysis of 11 RCTs suggests that neoadjuvant or perioperative treatment resulted in more favorable OS, EFS, and pathological response rates, supporting the use of these treatment regimens in this patient population. Meanwhile, adjuvant ICI significantly improved DFS with a trend towards improvement in OS.
•
Positive PD-L1 status, non-squamous histology, and stage III achieved a more profound EFS advantage. A longer, perioperative regimen might be required to improve survival outcomes in subgroups that obtained less advantage from ICI, such as squamous histology. Other clinical factors, such as age, sex, race, and geographical location, did not modify the benefit obtained from ICI, exhibiting the generalizability of ICI in different demographics.
•
Head-to-head studies to compare neoadjuvant versus perioperative ICI and the duration of adjuvant ICI should be further investigated to determine the optimal sequence and duration of ICI in patients with resectable NSCLC.
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