Background: The use of immunotherapy (IOT) in treating non-small-cell lung cancer (NSCLC) has revolutionized care standards. However, full compliance with neoadjuvant, perioperative, and adjuvant treatment protocols remains a challenge. This study aims to evaluate compliance rates with IOT-based protocols in neoadjuvant, adjuvant, and perioperative settings. Methods: A systematic review and meta-analysis were conducted on prospective clinical trials involving preoperative, perioperative, and postoperative IOT protocols in resectable NSCLC up to December 2024. Primary outcomes included compliance with medical treatment (e.g., omission of therapy rate, incomplete therapy rate, and omission of surgery rate), surgical outcomes (R0 resection rate), and post-treatment severe adverse events (AEs). Results: A total of 30 studies, with 10,493 patients, were included. In the neoadjuvant settings, 26 studies (16 neoadjuvant; 10 perioperative) investigated IOT alone or in combination with chemotherapy. Almost all patients received at least one therapy administration, while 11.3 % experienced incomplete cycles. Surgery was not performed in 16.1 % of cases, and an R0 resection was achieved in 80.5 % of patients. Grade ≥ 3 AEs were observed in 67.7 % of patients. In the adjuvant setting, 14 studies evaluated IOT (4 adjuvant; 10 perioperative). Complete omission of adjuvant therapy occurred in 9,6 % of patients, while 34,6 % required a discontinuation or cycle reduction. Grade ≥ 3 were AEs observed in 19.0 % of patients. Overall protocol compliance was superior in neoadjuvant protocols (effect size: 0.78 [IC 95 %: 0.70–0.85]) compared to adjuvant protocols (effect size: 0.61 [IC 95 %: 0.53–0.69]) and perioperative protocols (effect size: 0.49 [IC 95 %: 0.43–0.55]). However, perioperative protocols showed similar compliance and Grade ≥ 3 AE rates compared to preoperative and postoperative protocols. Conclusions: Compliance with treatment protocols in NSCLC remains a critical factor, particularly for radical surgery candidates. This study represents a landmark effort in synthesizing comprehensive data on compliance with immunotherapy protocols in resectable NSCLC. Improving protocol compliance through tailored strategies and multidisciplinary coordination is essential to maximize the therapeutic potential of immunotherapy in resectable NSCLC and enhance patient outcomes.
Attrition with adjuvant, neoadjuvant, and perioperative immunotherapy-based treatment protocols in patients with resectable non-small-cell lung cancer. A meta-analysis of prospective trials
Greco, Carlo;
2025-01-01
Abstract
Background: The use of immunotherapy (IOT) in treating non-small-cell lung cancer (NSCLC) has revolutionized care standards. However, full compliance with neoadjuvant, perioperative, and adjuvant treatment protocols remains a challenge. This study aims to evaluate compliance rates with IOT-based protocols in neoadjuvant, adjuvant, and perioperative settings. Methods: A systematic review and meta-analysis were conducted on prospective clinical trials involving preoperative, perioperative, and postoperative IOT protocols in resectable NSCLC up to December 2024. Primary outcomes included compliance with medical treatment (e.g., omission of therapy rate, incomplete therapy rate, and omission of surgery rate), surgical outcomes (R0 resection rate), and post-treatment severe adverse events (AEs). Results: A total of 30 studies, with 10,493 patients, were included. In the neoadjuvant settings, 26 studies (16 neoadjuvant; 10 perioperative) investigated IOT alone or in combination with chemotherapy. Almost all patients received at least one therapy administration, while 11.3 % experienced incomplete cycles. Surgery was not performed in 16.1 % of cases, and an R0 resection was achieved in 80.5 % of patients. Grade ≥ 3 AEs were observed in 67.7 % of patients. In the adjuvant setting, 14 studies evaluated IOT (4 adjuvant; 10 perioperative). Complete omission of adjuvant therapy occurred in 9,6 % of patients, while 34,6 % required a discontinuation or cycle reduction. Grade ≥ 3 were AEs observed in 19.0 % of patients. Overall protocol compliance was superior in neoadjuvant protocols (effect size: 0.78 [IC 95 %: 0.70–0.85]) compared to adjuvant protocols (effect size: 0.61 [IC 95 %: 0.53–0.69]) and perioperative protocols (effect size: 0.49 [IC 95 %: 0.43–0.55]). However, perioperative protocols showed similar compliance and Grade ≥ 3 AE rates compared to preoperative and postoperative protocols. Conclusions: Compliance with treatment protocols in NSCLC remains a critical factor, particularly for radical surgery candidates. This study represents a landmark effort in synthesizing comprehensive data on compliance with immunotherapy protocols in resectable NSCLC. Improving protocol compliance through tailored strategies and multidisciplinary coordination is essential to maximize the therapeutic potential of immunotherapy in resectable NSCLC and enhance patient outcomes.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
