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The use of neoadjuvant or perioperative anti-PD(L)1 was recently tested in multiple clinical trials. We performed a systematic review and meta-analysis of randomised trials comparing neoadjuvant or perioperative chemoimmunotherapy to neoadjuvant chemotherapy in resectable NSCLC. Nine reports from 6 studies were included. Receipt of surgery was more frequent in the experimental arm (odds ratio, OR 1.39) as was pCR (OR 7.60). EFS was improved in the experimental arm (hazard ratio, HR 0.55) regardless of stage, histology, PD-L1 expression (PD-L1 negative, HR 0.74) and smoking exposure (never smokers, HR 0.67), as was OS (HR 0.67). Grade > = 3 treatment-related adverse events were more frequent in the experimental arm (OR 1.22). The experimental treatment improved surgical outcomes, pCR rates, EFS and OS in stage II-IIIB, EGFR/ALK negative resectable NSCLC; confirmatory evidence is warranted for stage IIIB tumours and with higher maturity of the OS endpoint. • Perioperative ICIs plus with neoadjuvant chemotherapy improves surgical outcomes. • Perioperative ICIs plus with neoadjuvant chemotherapy improves pCR, EFS and OS. • PD-L1 negative NSCLC benefits from chemoimmunotherapy combinations. • Higher rates of grade > = 3 adverse events were associated with experimental treatment. • Confirmatory evidence is warranted in stage IIIB tumours.
Marinelli et al. (Sat,) studied this question.
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