PMID- 38454928
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240309
IS  - 2234-943X (Print)
IS  - 2234-943X (Electronic)
IS  - 2234-943X (Linking)
VI  - 14
DP  - 2024
TI  - Perioperative immunotherapy for stage II-III non-small cell lung cancer: a 
      meta-analysis base on randomized controlled trials.
PG  - 1351359
LID - 10.3389/fonc.2024.1351359 [doi]
LID - 1351359
AB  - BACKGROUND: In recent years, we have observed the pivotal role of immunotherapy 
      in improving survival for patients with non-small cell lung cancer (NSCLC). 
      However, the effectiveness of immunotherapy in the perioperative (neoadjuvant + 
      adjuvant) treatment of resectable NSCLC remains uncertain. We conducted a 
      comprehensive analysis of its antitumor efficacy and adverse effects (AEs) by 
      pooling data from the KEYNOTE-671, NADIM II, and AEGEAN clinical trials. METHODS: 
      For eligible studies, we searched seven databases. The randomized controlled 
      trials (RCTs) pertaining to the comparative analysis of combination neoadjuvant 
      platinum-based chemotherapy plus perioperative immunotherapy (PIO) versus 
      perioperative placebo (PP) were included. Primary endpoints were overall survival 
      (OS) and event-free survival (EFS). Secondary endpoints encompassed drug 
      responses, AEs, and surgical outcomes. RESULTS: Three RCTs (KEYNOTE-671, NADIM 
      II, and AEGEAN) were included in the final analysis. PIO group (neoadjuvant 
      platinum-based chemotherapy plus perioperative immunotherapy) exhibited superior 
      efficacy in OS (hazard ratio [HR]: 0.63 [0.49-0.81]), EFS (HR: 0.61 [0.52, 
      0.72]), objective response rate (risk ratio [RR]: 2.21 [1.91, 2.54]), 
      pathological complete response (RR: 4.36 [3.04, 6.25]), major pathological 
      response (RR: 2.79 [2.25, 3.46]), R0 resection rate (RR: 1.13 [1.00, 1.26]) and 
      rate of adjuvant treatment (RR: 1.08 [1.01, 1.15]) compared with PP group 
      (neoadjuvant platinum-based chemotherapy plus perioperative placebo). In the 
      subgroup analysis, EFS tended to favor the PIO group in almost all subgroups. BMI 
      (>25), T stage (IV), N stage (N1-N2) and pathological response (with pathological 
      complete response) were favorable factors in the PIO group. In the safety 
      assessment, the PIO group exhibited higher rates of serious AEs (28.96% vs. 
      23.51%) and AEs leading to treatment discontinuation (12.84% vs. 5.81%). 
      Meanwhile, although total adverse events, grade 3-5 adverse events, and fatal 
      adverse events tended to favor the PP group, the differences were not 
      statistically significant. CONCLUSION: PIO appears to be superior to PP for 
      resectable stage II-III NSCLC, demonstrating enhanced survival and pathological 
      responses. However, its elevated adverse event (AE) rate warrants careful 
      consideration. SYSTEMATIC REVIEW REGISTRATION: 
      https://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier CRD42023487475.
CI  - Copyright (c) 2024 Yu, Fu, Li, Wu, Yu and Zhang.
FAU - Yu, Anping
AU  - Yu A
AD  - Department of Oncology, Fengcheng People's Hospital, Yichun, China.
AD  - Department of Oncology, The Affiliated Fengcheng Hospital of Yichun University, 
      Yichun, China.
FAU - Fu, Feng
AU  - Fu F
AD  - Department of Oncology, Shangrao People's Hospital, Shangrao, China.
FAU - Li, Xiongying
AU  - Li X
AD  - Department of Oncology, Fengcheng People's Hospital, Yichun, China.
AD  - Department of Oncology, The Affiliated Fengcheng Hospital of Yichun University, 
      Yichun, China.
FAU - Wu, Mengxin
AU  - Wu M
AD  - Department of Oncology, Shangrao People's Hospital, Shangrao, China.
FAU - Yu, Meijian
AU  - Yu M
AD  - Department of Oncology, Shangrao People's Hospital, Shangrao, China.
FAU - Zhang, Wenxiong
AU  - Zhang W
AD  - Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang 
      University, Nanchang, China.
LA  - eng
PT  - Systematic Review
DEP - 20240222
PL  - Switzerland
TA  - Front Oncol
JT  - Frontiers in oncology
JID - 101568867
PMC - PMC10917905
OTO - NOTNLM
OT  - adjuvant
OT  - immunotherapy
OT  - meta-analysis
OT  - neoadjuvant
OT  - non-small cell lung cancer
OT  - surgery
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2024/03/08 06:43
MHDA- 2024/03/08 06:44
PMCR- 2024/01/01
CRDT- 2024/03/08 03:54
PHST- 2023/12/06 00:00 [received]
PHST- 2024/02/05 00:00 [accepted]
PHST- 2024/03/08 06:44 [medline]
PHST- 2024/03/08 06:43 [pubmed]
PHST- 2024/03/08 03:54 [entrez]
PHST- 2024/01/01 00:00 [pmc-release]
AID - 10.3389/fonc.2024.1351359 [doi]
PST - epublish
SO  - Front Oncol. 2024 Feb 22;14:1351359. doi: 10.3389/fonc.2024.1351359. eCollection 
      2024.