Efficacy and safety of neoadjuvant combination immunotherapy in surgically resectable malignant solid tumors: a systematic review and meta-analysis

ABSTRACT

Objectives

Neoadjuvant immunotherapy has emerged as a prominent research focus recently. For potentially operable patients, neoadjuvant therapy serves as a primary method to reduce tumor load and facilitate surgical interventions.

Methods

We retrieved articles from PubMed, Embase, Cochrane Library, American Society of Clinical Oncology, and European Society of Medical Oncology websites from inception to December 2023. Statistical analyses were performed using the R software. Primary outcomes assessed included major pathological response (MPR), pathological complete response (pCR), and treatment-related adverse events (trAEs).

Results

29 studies encompassing 1163 patients were included. The MPR rate of neoadjuvant combination immunotherapy was 38% (95% confidence interval [CI]: 25%–52%), and the pCR rate was 33% (95%CI: 25%–42%). These values were significantly higher than those obtained with single agent immunotherapy (p < 0.001). The pooled incidence of overall trAEs was 83% (95%CI: 73%–92%), and grade (G) 3–4 trAEs was 22% (95%CI: 15%–29%), both significantly higher than those observed with single agent immunotherapy (p < 0.05).

Conclusion

This study demonstrated the efficacy of neoadjuvant combination immunotherapy. Given that the majority of the included trials were phase II with small sample sizes, further multicenter phase III randomized controlled trials should be conducted to validate the findings of the review.

KEYWORDS:

• Neoadjuvant therapy
• combination immunotherapy
• resectable tumors
• efficacy
• safety

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

A reviewer on this manuscript has disclosed being on the advisory board for Novartis and receiving speaker’s fees from Novartis, MSD and AstraZeneca. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14737140.2024.2325404

Acknowledgments

The authors would like to thank Editage (http://www.editage.cn) for English language editing.

Author contributions

Shengyou Lin had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: Yuqian Feng, Shengyou Lin. Acquisition, analysis, or interpretation of data: Yuqian Feng, Kaibo Guo. Drafting of the manuscript: Yuqian Feng, Kaibo Guo. Critical revision of the manuscript for important intellectual content: Huimin Jin, Jing Jiang, Menglei Wang. Statistical analysis: Yuqian Feng, Kaibo Guo. Obtained funding: Shengyou Lin. Administrative, technical, or material support: Shengyou Lin. Supervision: Shengyou Lin.

Data availability statement

Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author on reasonable request.

Additional information

Funding

This paper was funded by Zhejiang Lin Shengyou famous traditional Chinese medicine expert inheritance studio project [GZS202002].