新辅助免疫化疗对可切除I-III期非小细胞肺癌的疗效和安全性:系统综述和网络荟萃分析

Bo li, Yujia Gu, Weixing Zhao, Zirui Li, Wanjing Guo, Xinxin Lu, Jun Jiang
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引用次数: 0

摘要

背景新辅助免疫化疗(NICT)是一种治疗可切除非小细胞肺癌(NSCLC)的新方法。方法我们在PubMed、Embase、Web of Science、Cochrane图书馆和国际会议上搜索了将NICT与新辅助化疗(NCT)进行比较的随机对照试验(RCT)。结果纳入了3387名患者、六种治疗组合和两种模式的研究。Meta分析表明,NICT的pCR和EFS率高于NCT。托利帕利单抗-化疗组合的手术切除率(OR = 1.68,95% CI:1.05-2.73)、pCR(OR = 38.84,95% CI:11.05-268.19)和EFS(HR = 0.40,95% CI:0.28-0.58)最高。对于PD-L1高表达和NSCLC患者,新辅助nivolumab联合化疗的疗效最好。治疗相关不良事件的发生率随着治疗周期的延长而增加,围手术期nivolumab联合化疗的安全性最差(RR=1.32,95% CI:1.00-1.76),而新辅助nivolumab单独联合化疗的安全性最好(RR=0.91,95% CI:0.68-1.21)。间接比较显示,新辅助-辅助免疫疗法没有生存获益(HR = 0.93,95% CI:0.65-1.35)。在两种免疫检查点抑制剂(ICIs)的间接比较中,虽然EFS没有显著差异(HR=0.81,95% CI:0.61-1.08),但PD-1抑制剂仍可能是最有效的治疗方案。最佳治疗组合通常是托瑞帕单抗和化疗。建议根据 PD-L1 表达和病理类型进行治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

The efficacy and safety of neoadjuvant immunochemotherapy in resectable stage I-III non-small cell lung cancer: a systematic review and network meta-analysis

The efficacy and safety of neoadjuvant immunochemotherapy in resectable stage I-III non-small cell lung cancer: a systematic review and network meta-analysis

Background

Neoadjuvant immunochemotherapy (NICT) is a new treatment method for resectable non-small-cell lung cancer (NSCLC). Network meta-analysis assessed efficacy, safety, and optimal treatment.

Methods

We searched for randomized controlled trials (RCTs) comparing NICT with neoadjuvant chemotherapy (NCT) in PubMed, Embase, Web of Science, Cochrane Library, and international conferences. Outcomes were surgical resection rate, pathological complete response(pCR),event-free survival (EFS), and Grade 3–5 treatment-related adverse events (TRAEs).

Results

RCTs of 3,387 patients, six treatment combinations, and two modalities were included. Meta-analysis showed that NICT yielded higher pCR and EFS rates than NCT. The toripalimab-chemotherapy combination had the highest surgical resection rate (OR = 1.68, 95% CI: 1.05–2.73), pCR (OR = 38.84, 95% CI: 11.05–268.19) and EFS (HR = 0.40, 95% CI: 0.28–0.58).This regimen worked well for patients with low programmed death-ligand 1 (PD-L1) expression or squamous cell pathology. For high PD-L1 expression and patients with NSCLC, neoadjuvant nivolumab with chemotherapy had the most efficacy. The incidence of treatment-related adverse events increased with longer treatment cycles, with perioperative nivolumab combined with chemotherapy showing the worst safety profile (RR = 1.32, 95% CI: 1.00–1.76), while neoadjuvant nivolumab combined with chemotherapy alone had the best safety profile (RR = 0.91, 95% CI: 0.68–1.21). Indirect comparison showed no survival benefit for neoadjuvant-adjuvant immunotherapy (HR = 0.93, 95% CI: 0.65–1.35). In the indirect comparison between the two immune checkpoint inhibitors(ICIs), although there was no significant difference in EFS (HR = 0.81, 95% CI: 0.61–1.08), PD-1 inhibitors may still be the most effective treatment option.

Conclusions

NICT effectively and safely treats resectable NSCLC. The optimal treatment combination is typically toripalimab and chemotherapy. Treatment based on PD-L1 expression and pathological type is recommended.

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