The following is a summary of “Comparative efficacy and safety of first-line neoadjuvant therapy for early-stage non-small cell lung cancer based on immune checkpoint inhibitor therapy: a systematic review and network meta-analysis,” published in the January 2025 issue of Pulmonology by Wang et al. 

Researchers conducted a retrospective study to evaluate optimal neoadjuvant immunotherapy combinations for patients with perioperative non-small cell lung cancer (NSCLC), as no definitive strategy had been established.   

They searched PubMed, EMBASE, Cochrane Library, ClinicalTrials.gov, and randomized controlled trials (RCTs) from major international conferences for literature on neoadjuvant immunotherapy combinations published as first-line treatments for NSCLC. The search covered the period from the inception of these databases up until 20 February 2024 with a systematic review and network meta-analysis based on the identified studies.  

The results showed that 9 studies with 3,431 patients evaluated 8 perioperative neoadjuvant immunotherapy combinations for NSCLC. For patients without programmed death-ligand 1 (PD-L1) selection, toripalimab plus chemotherapy showed the highest benefits in pathological complete response (PCR) (OR = 32.89, 95% CI: 7.88-137.32), major pathological response (MPR) (OR = 10.25, 95% CI: 5.81–18.10), and event-free survival (EFS) (HR = 0.40, 95% CI: 0.28–0.57). Nivolumab plus chemotherapy had the highest surgical resection rate (OR = 1.71, 95% CI: 0.87–3.40), while pembrolizumab plus chemotherapy had the best R0 surgical resection rate (OR = 2.20, 95% CI: 1.28–3.79). The combination of ipilimumab, nivolumab, and chemotherapy, as well as toripalimab and chemotherapy, had the lowest incidence of grade 3 or above adverse events (AEs).   

Investigators concluded that toripalimab plus chemotherapy demonstrated superior neoadjuvant efficacy and potential overall survival benefit but also increased serious AEs during neoadjuvant therapy. 

Source: bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-025-03479-2