Neoadjuvant therapy in resectable small-cell lung cancer: A systematic review and meta-analysis.

Abstract

e20101 Background: Surgery, chemotherapy, and immunotherapy constitute the cornerstone therapeutic regimen for patients with small-cell lung cancer (SCLC). However, there is limited evidence of neoadjuvant therapy for resectable SCLC. Therefore, we conducted the first systematic review and meta-analysis to investigate the efficacy and safety of neoadjuvant treatment for patients with SCLC. Methods: This study was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis 2020 statement. A comprehensive search was conducted across PubMed, Embase, Cochrane Library, Web of Science, and Google Scholar up to December 31, 2024, including studies that evaluated the efficacy and safety of neoadjuvant therapy for resectable SCLC patients. The heterogeneity was assessed using I 2 statistics; the random-effects model was conducted if I 2 > 50%; otherwise, a fixed-effects model was used. This study evaluated the pathological complete response (pCR), major pathological response (MPR), R0 resection rate, and grade 3-4 adverse events (AEs). Results: This study identified 663 literature, and 10 studies involving 228 SCLC patients met the inclusion criteria. The age of SCLC patients ranged from 32-76 years, and the clinical stage was ⅠA-ⅢB. The pooled pCR, MPR, and R0 resection rates were 36.5% (95% CI: 19.8-54.8; I 2 =76.26%; 6 studies; n=133), 51.8% (95% CI: 31.8-71.5; I 2 =82.31%; 6 studies; n=141), and 81.2% (95% CI: 68.2-91.8; I 2 =54.93%; 5 studies; n=115), respectively. According to the subgroup analysis stratified by different neoadjuvant regimens, the pCR and MPR of neoadjuvant immunochemotherapy were statistically significantly higher ( P < 0.0001) than those of neoadjuvant chemotherapy. The pCR was 48.4% (95% CI: 37.7-59.1; I 2 =5.92%; 6 studies; n=93) for neoadjuvant immunochemotherapy and 7.4% (95% CI: 0.6-18.5; I 2 =0%; 2 studies; n=40) for neoadjuvant chemotherapy. The MPR was 65.4% (95% CI: 52.5-77.4; I 2 =38.94%; 6 studies; n=101) for neoadjuvant immunochemotherapy and 14.7% (95% CI: 4.7-28.0; I 2 =0%; 2 studies; n=40) for neoadjuvant chemotherapy. There was no significant difference in R0 resection rates between neoadjuvant chemotherapy (81.3%, 95% CI: 68.6-91.5; I 2 =0%; 2 studies; n=48) and neoadjuvant immunochemotherapy (81.7%, 95% CI: 58.4-97.6; I 2 =72.74%; 4 studies; n=67). The pooled incidence of grade 3-4 AEs was 42.0% (95% CI: 26.5-58.2; I 2 =64.18%; 6 studies; n=126); 43.7% (95% CI: 25.5-62.6; I 2 =69.41%; 6 studies; n=111) for neoadjuvant immunochemotherapy; and only one study reported this result following neoadjuvant chemotherapy (33.3%, 95% CI: 11.8-61.6; n=15). Conclusions: Neoadjuvant therapy, particularly neoadjuvant immunochemotherapy, can provide short-term benefits to resectable SCLC patients, and additional prospective high-quality studies are needed.