Scholarlink

Purpose <p>This network meta-analysis evaluated neoadjuvant chemoimmunotherapy efficacy and safety in elderly patients with resectable non-small cell lung cancer (NSCLC).</p> Methods <p>We conducted a systematic review and Bayesian network meta-analysis by searching PubMed, Web of Science, Cochrane Library (All Databases), and EMBASE (including MEDLINE). The endpoints for this analysis were event-free survival (EFS), pathological complete response (pCR), and adverse events of grade 3 or higher (AEs ≥ 3).</p> Results <p>We analyzed 8 RCTs, including 6 neoadjuvant plus adjuvant immunotherapy with preoperative chemotherapy (Neo-adj) and 2 neoadjuvant immunotherapy with preoperative chemotherapy (Neo) trials, involving 1,556 elderly patients and covering 7 treatment regimens. In elderly patients, Neo-adj outperformed neoadjuvant chemotherapy (CT) in EFS (HR = 0.60, 95%CI:0.41–0.81) and pCR (OR = 7.29, 95%CI:1.58–34.73). Neo-adj versus Neo demonstrated no significant difference in EFS (HR = 0.86, 95%CI:0.35–1.91) and pCR (OR = 1.11, 95%CI:0.05–25.88). Tislelizumab plus CT showed the greatest pCR benefit (OR = 15.82, 95%CI:1.05–248.39). In patients aged &lt; 65&#xa0;years, Neo-adj surpassed CT in EFS (HR = 0.54, 95%CI:0.41–0.72) and pCR (OR = 7.44, 95%CI:3.1–17.86). Neo-adj versus Neo demonstrated no significant differences in EFS (HR = 0.96, 95%CI:0.45–2.03) and pCR (OR = 1.98, 95%CI:0.22–14.91). Nivolumab plus CT demonstrated notably higher pCR versus CT (OR = 7.05, 95%CI:1.01–49.66). In the overall population, no significant differences were observed in AEs ≥ 3 between Neo-adj and Neo, as well as among different regiments.</p> Conclusion <p>Neo-adj may be optimal treatment strategy for resectable NSCLC in both younger (&lt; 65&#xa0;years) and elderly patients. In elderly patients, tislelizumab plus chemotherapy seems to offer the best therapeutic effect. Nivolumab plus chemotherapy appears more effective in younger patients. Notably, Safety profiles remain clinically manageable despite adverse events.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Efficacy and safety of neoadjuvant chemoimmunotherapy in elderly patients with resectable non-small cell lung cancer: a network meta-analysis and systematic review

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年9月24日

查看全文
  • Yufeng Liu,
  • Pirong Yang,
  • Qiwei Feng,
  • Juan Li

摘要

Purpose

This network meta-analysis evaluated neoadjuvant chemoimmunotherapy efficacy and safety in elderly patients with resectable non-small cell lung cancer (NSCLC).

Methods

We conducted a systematic review and Bayesian network meta-analysis by searching PubMed, Web of Science, Cochrane Library (All Databases), and EMBASE (including MEDLINE). The endpoints for this analysis were event-free survival (EFS), pathological complete response (pCR), and adverse events of grade 3 or higher (AEs ≥ 3).

Results

We analyzed 8 RCTs, including 6 neoadjuvant plus adjuvant immunotherapy with preoperative chemotherapy (Neo-adj) and 2 neoadjuvant immunotherapy with preoperative chemotherapy (Neo) trials, involving 1,556 elderly patients and covering 7 treatment regimens. In elderly patients, Neo-adj outperformed neoadjuvant chemotherapy (CT) in EFS (HR = 0.60, 95%CI:0.41–0.81) and pCR (OR = 7.29, 95%CI:1.58–34.73). Neo-adj versus Neo demonstrated no significant difference in EFS (HR = 0.86, 95%CI:0.35–1.91) and pCR (OR = 1.11, 95%CI:0.05–25.88). Tislelizumab plus CT showed the greatest pCR benefit (OR = 15.82, 95%CI:1.05–248.39). In patients aged < 65 years, Neo-adj surpassed CT in EFS (HR = 0.54, 95%CI:0.41–0.72) and pCR (OR = 7.44, 95%CI:3.1–17.86). Neo-adj versus Neo demonstrated no significant differences in EFS (HR = 0.96, 95%CI:0.45–2.03) and pCR (OR = 1.98, 95%CI:0.22–14.91). Nivolumab plus CT demonstrated notably higher pCR versus CT (OR = 7.05, 95%CI:1.01–49.66). In the overall population, no significant differences were observed in AEs ≥ 3 between Neo-adj and Neo, as well as among different regiments.

Conclusion

Neo-adj may be optimal treatment strategy for resectable NSCLC in both younger (< 65 years) and elderly patients. In elderly patients, tislelizumab plus chemotherapy seems to offer the best therapeutic effect. Nivolumab plus chemotherapy appears more effective in younger patients. Notably, Safety profiles remain clinically manageable despite adverse events.