Efficacy and safety of immunotherapy plus chemotherapy for lung cancer neoadjuvant treatment: A network meta-analysis based on randomized controlled trials.

8026 Background: With immunotherapy's swift progress in lung cancer treatment, combining immunotherapy with chemotherapy (CT) for neoadjuvant use has attracted significant interest, though direct comparisons of its efficacy and safety are still scarce. This study aims to comprehensively evaluate the efficacy and safety of immunotherapy combined with chemotherapy versus chemotherapy alone in the neoadjuvant treatment of lung cancer. Methods: We searched databases, including PubMed and EMBASE, for phase II and III randomized global trials that assessed neoadjuvant lung cancer treatment with immunotherapy combined with chemotherapy. We performed a Bayesian random-effects network meta-analysis to evaluate efficacy, presenting Hazard Ratios (HRs) and 95% Confidence Intervals (95%CI). Bias risk was determined using the Cochrane risk of bias tool, and evidence quality was appraised via the CINeMA framework. Results: Our analysis included eight randomized controlled trials, comprising a total of 3,316 patients. The results indicated that, compared to neoadjuvant chemotherapy alone, the Event-Free Survival (EFS) was highest for the durvalumab+CT group, ranking first with an HR of 2 (95% CI: 1.0 to 3.7). The pembrolizumab+CT group ranked second with an HR of 1.8 (95% CI: 0.76 to 4.2), followed by the nivolumab+CT group in third place with an HR of 1.7 (95% CI: 0.95 to 3.1). Both the nivolumab and ipilimumab+CT and toripalimab+CT groups tied for fourth place with HRs of 1.4 (95% CI: 0.58 to 3.5) and 1.5 (95% CI: 0.70 to 3.2), respectively. The camrelizumab+CT group had the lowest EFS ranking, with an HR of 1.7 (95% CI: 0.74 to 3.8). The combination of nivolumab+ipilimumab+CT showed the most favorable outcomes in terms of Pathologic Complete Response (PCR) and R0 resection rates among the six treatments, with lnOR values of 3.17 and 1.48, respectively. This combination also had the lowest occurrence of treatment-related adverse events greater than grade 3, with an lnOR value of -1.38. Conclusions: This network meta-analysis indicates that durvalumab, when combined with chemotherapy, offers the best EFS among the immunotherapy options evaluated, demonstrating good safety and efficacy. Concurrent use of nivolumab and ipilimumab resulted in the highest pCR and R0 resection rates. Moreover, for patients with lung cancer, the preliminary evidence supports the value of combining immunotherapy with chemotherapy as a neoadjuvant treatment strategy over chemotherapy alone. [Table: see text]