Treatment interruption during neoadjuvant immuno-chemotherapy for non-small-cell lung cancer: a systematic review and meta-analysis of randomized controlled trials.

Background: Neoadjuvant immuno-chemotherapy has been verified as a promising treatment for early-stage non-small-cell lung cancer (NSCLC). However, its risk of pre-operative treatment interruption was unclear. This study aimed to evaluate and compare the risk of pre-operative treatment interruption between different neoadjuvant therapy (NAT) strategies in early-stage NSCLC. Methods: We searched MEDLINE, Embase, and the Cochrane Library for randomized controlled trials (RCTs) reporting on NAT in NSCLC up to July 3, 2024. Eligible studies reporting pre-operative treatment interruption were included. Paired meta-analysis and Bayesian network meta-analysis (NMA) were conducted to compare the risk between different NAT strategies. The primary outcome was pre-operative treatment interruption, which included neoadjuvant treatment discontinuation, surgery delay and surgery cancellation. Results: Compared with neoadjuvant chemotherapy, neoadjuvant immuno-chemotherapy was associated with a higher risk of adverse event (AE)-related NAT discontinuation [risk ratio (RR), 1.32; 95% confidence interval (CI): 1.00-1.73; I Conclusions: Neoadjuvant immuno-chemotherapy did not increase the risk of NAT discontinuation and surgery delay. On the contrary, it is associated with a reduced risk of surgery cancellation, particularly in cases of cancellation due to PD. These findings suggested extra advantage of neoadjuvant immuno-chemotherapy in the management of early-stage NSCLC (CRD42024570066).