Neoadjuvant radio-chemoimmunotherapy versus neoadjuvant chemoimmunotherapy for resectable non-small cell lung cancer: A pooled analysis of prospective studies.

e20063 Background: Neoadjuvant chemoimmunotherapy (CI) is the standard of care for locally advanced, resectable non-small cell lung cancer (NSCLC). Due to their synergistic effects, the addition of radiotherapy to neoadjuvant CI may improve therapeutic outcomes. This study aims to compare the safety and efficacy of neoadjuvant radio-chemoimmunotherapy (RCI) with neoadjuvant CI in patients with resectable NSCLC. Methods: We searched PubMed and Embase databases for prospective studies featuring 10 or more patients with resectable NSCLC. The primary outcome was the pathological major response rate (MPR), and secondary outcomes included the pathological complete response rate (pCR), overall resection rate, and rates of adverse events. Odds ratios were calculated using pooled outcome data. The review protocol was registered with PROSPERO (CRD42024537822). Results: We identified five studies that included 149 patients (74% male, median age range 62-66, 92% with stage 3 disease) treated with neoadjuvant RCI, including one randomised trial and four single-arm trials. Fifteen studies included 2010 patients (75% male, median age range 43-67, 75% with stage 3 disease) treated with neoadjuvant CI, including eight randomised trials and seven single-arm trials. The odds of achieving a MPR and pCR were significantly higher for those treated with neoadjuvant RCI (MPR: OR 2.44, 95% CI 1.73 – 3.45, p<0.001 and pCR: OR 1.89, 95% CI 1.34 – 2.66, p<0.001). There was no significant difference in resection rate between groups; 13% failed to complete resection after neoadjuvant RCI compared to 18% after neoadjuvant CI (OR 0.65, 95% CI 0.37 - 1.07, p=0.083). There was no significant difference between groups in the rate of Grade 3+ adverse events (OR 0.72, 95% CI 0.50 - 1.02, p=0.055). Conclusions: Neoadjuvant radio-chemoimmunotherapy may lead to improved major and complete pathological response rates than neoadjuvant chemoimmunotherapy, without an increase in toxicity or reduction in resection rates.