ArticleJournal of thoracic disease2026
Optimal duration of adjuvant immunotherapy after neoadjuvant chemoimmunotherapy in resectable non-small cell lung cancer: a systematic review and meta-analysis.
Article in Journal of thoracic disease, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The optimal duration of adjuvant immunotherapy following neoadjuvant chemoimmunotherapy and surgery for resectable non-small cell lung cancer (NSCLC) remains unclear. This systematic review and meta-analysis aimed to compare the efficacy of 12/13-cycle versus 6/8-cycle adjuvant programmed cell death 1/programmed death-ligand 1 (PD-1/PD-L1) inhibitor therapy in this clinical setting. Methods: A systematic search of PubMed, Embase, the Cochrane Library, and major oncology conferences was performed from database inception to July 31, 2024. Eligible studies were phase II/III randomized controlled trials evaluating perioperative PD-1/PD-L1 inhibitor plus neoadjuvant chemotherapy compared with neoadjuvant chemotherapy alone. Hazard ratios (HRs) for survival outcomes were synthesized using the inverse-variance method. Indirect comparisons between the 12/13-cycle and 6/8-cycle adjuvant immunotherapy were performed using frequentist methods, with chemotherapy as a common comparator. The primary outcome was event-free survival (EFS). Results: Four trials involving 12/13-cycle adjuvant immunotherapy and two trials with 6/8-cycle regimens, totaling 3,003 patients, were included. Direct meta-analysis demonstrated significant improvements in EFS for chemoimmunotherapy compared with chemotherapy alone in both 12/13-cycle and 6/8-cycle adjuvant groups. In the indirect comparison, 12/13 cycles of adjuvant immunotherapy did not significantly improve EFS (HR, 1.05; 95% confidence interval: 0.77-1.45) compared with the 6/8-cycle regimen. However, a trend favoring 12/13 cycles of adjuvant therapy was observed in the PD-L1 expression ≥50% subgroup (P for interaction =0.02). Conclusions: Adjuvant immunotherapy with 6-8 cycles may be sufficient for patients with resectable NSCLC who have already received neoadjuvant chemoimmunotherapy. Further clinical trials are needed to determine the optimal duration of adjuvant therapy, particularly for patients with PD-L1 ≥50%.
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