Neoadjuvant versus perioperative chemo-immunotherapy according to pathological response in resectable NSCLC: a reconstructed individual patient data meta-analysis

Abstract

Neoadjuvant chemo-immunotherapy transformed early-stage non-small cell lung cancer (NSCLC) treatment. However, the prognostic value of different pathological responses and the impact of adjuvant immunotherapy within a chemo-immunotherapy perioperative strategy remains unclear. We estimated time-to-event outcomes by graphical reconstruction of event-free survival (EFS) curves by pathological response (pCR, MPR, no-MPR) reported in early-stage NSCLC neoadjuvant/perioperative chemo-immunotherapy trials. MPR 1-10% subgroup, previously unreported, was retrieved by removing patients achieving pCR from the MPR group. Survival analysis by pathological response and comparison between neoadjuvant/perioperative strategies within subgroups were assessed. A statistically significant EFS difference according to pathological response was found, showing a prognostic gradient shifting from pCR (good), MPR 1-10% (intermediate) and no-MPR (poor). There was no difference between neoadjuvant/perioperative strategies within subgroups, however a trend for EFS benefit with perioperative and neoadjuvant chemo-immunotherapy was observed in MPR 1-10% and no-MPR patients, respectively. In conclusio, a pathological response-based algorithm could better tailor early-stage NSCLC treatment.

Accepted manuscripts

Accepted manuscripts are PDF versions of the author’s final manuscript, as accepted for publication by the journal but prior to copyediting or typesetting. They can be cited using the author(s), article title, journal title, year of online publication, and DOI. They will be replaced by the final typeset articles, which may therefore contain changes. The DOI will remain the same throughout.