The efficacy analysis of neoadjuvant chemoimmunotherapy followed by surgery in stage III locally advanced non-small cell lung cancer: a systematic review and meta-analysis

Locally advanced non-small cell lung cancer (NSCLC) has the potential for surgical cure after neoadjuvant immunotherapy in the era of immunotherapy. In this study, we conducted a meta-analysis of published data to systematically assess the efficacy and safety of neoadjuvant chemoimmunotherapy for stage III NSCLC. A comprehensive search was conducted on the Cochrane Library, PubMed, Web of Science, and Embase databases from January, 2000 to September, 2024 to identify studies concentrated on neoadjuvant chemoimmunotherapy followed by surgery for treating stage III NSCLC. The effectiveness and safety data were collected for meta-analysis. Study endpoints included resection rate, major pathological response (MPR), pathological complete response (pCR), objective response rate (ORR), treatment-related adverse events (TRAEs), severe adverse events (SAEs). Data analysis was conducted using R 4.1.3 software, and P < 0.05 was considered statistically significant. A total of 1043 patients from 22 studies were included in this meta-analysis, of whom 892 cases underwent surgery. The pooled MPR rate, pCR rate, and ORR rate were 65%, 38%, and 73%, respectively. The pooled incidence of TRAEs was 84% and the pooled incidence of SAEs was 13%. The results of the subgroup analysis showed that nivolumab- and pembrolizumab-based neoadjuvant chemoimmunotherapy showed a higher MPR rate (nivolumab 69%, pembrolizumab 68%) and pCR rate (nivolumab 51%, pembrolizumab 38%) than other immune checkpoint inhibitors (ICIs). Neoadjuvant chemoimmunotherapy demonstrates clinical benefits for patients with stage III NSCLC.