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

Background Recent randomized controlled trials (RCTs) have shown that neoadjuvant or adjuvant treatment with immune checkpoint inhibitors (ICIs) and chemotherapy improves survival outcomes for patients with resectable non-small cell lung cancer (NSCLC). We conducted this meta-analysis of RCTs to determine the survival benefits according to the clinical characteristics and treatment sequence. Materials and methods All phase II or III RCTs with resectable NSCLC patients that reported overall survival (OS), event-free survival (EFS), disease-free survival (DFS), or pathological complete remission were identified from CENTRAL, Embase, and Medline databases. One arm must receive ICI(s) with or without chemotherapy (CTX); another must receive CTX alone as neoadjuvant, adjuvant, or perioperative therapy. Effect estimates and 95% confidence interval (CI) were combined from each study to determine the pooled hazard ratio (HR) using the generic-inverse variance method. Results Eleven RCTs were included in the meta-analysis. Neoadjuvant or perioperative ICI treatment significantly improved OS (pooled HR 0.66, 95% CI 0.55-0.79) and EFS (HR 0.59, 95% CI 0.53-0.67). Adjuvant ICI regimens significantly improved DFS but not OS (pooled HR 0.77, 95% CI 0.67 – 0.89 and 0.94, 95% CI 0.78 – 1.12, respectively). Favorable EFS trends towards perioperative and neoadjuvant ICI were noted in patients with positive PD-L1 status and stage III disease. Conclusions Neoadjuvant and perioperative treatment with CTX and ICI improved survival in resectable NSCLC compared to CTX alone. Further studies are needed to determine the optimal treatment duration in this patient population.