Adoptive Immunotherapy in Postoperative Non-Small-Cell Lung Cancer: A Systematic Review and Meta-Analysis

<div><p>Background</p><p>Adoptive immunotherapy (AI) has been applied in the treatment of non-small-cell lung cancer (NSCLC) patients, but the value of postoperative AI has been inconclusive largely as a result of the small number of patients included in each study. We performed a systematic review and meta-analysis to address this issue for patients with postoperative NSCLC.</p><p>Methods</p><p>Pubmed, Embase, Cochrane Library were searched for randomized controlled trials comparing adoptive immunotherapy with control therapies in postoperative NSCLC patients. The primary endpoint was overall survival. Hazard ratio (HR) was estimated and 95% confidence intervals (CI) were calculated using a fixed-effect model.</p><p>Results</p><p>Compared with control therapies, analyses of 4 randomized controlled trials (472 patients) showed a significant benefit of adoptive immunotherapy on survival (hazard ratio [HR] 0.61, 95% CI 0.45–0.84, p = 0.002), and a 39% reduction in the relative risk of death (no evidence of a difference between trials; p = 0.16, I² = 42%). In subgroup analyses by treatment cycles and treatment regimen, significant OS benefit was found in combination therapy of AI with chemotherapy, regardless of whether or not the treatment cycles were more than 10 cycles.</p><p>Conclusion</p><p>Adoptive immunotherapy has the potential to improve overall survival in postoperative NSCLC. The findings suggest this is a valid treatment option for these patients. Further randomized clinical trials are urgently needed.</p></div

The total funnel plot of all groups.

<p>The total funnel plot of all groups.</p

Characteristics of Included Studies for Meta-Analysis.

<p>Characteristics of Included Studies for Meta-Analysis.</p

Forest plot of hazard ratio (HR) of overall survival in AI group versus control group.

<p>Forest plot of hazard ratio (HR) of overall survival in AI group versus control group.</p

Risk of bias in included studies.

<p>Risk of bias in included studies.</p

Results of subgroup analysis according to treatment line, treatment regimens for Meta-Analysis.

<p>Results of subgroup analysis according to treatment line, treatment regimens for Meta-Analysis.</p

Selection and evaluation process of the eligible studies in the meta-analysis.

<p><i>From</i>: Moher D, Liberati A, Tefclaff J, Altman DG, The PRISMA Group (2009). /deferred Reporting /terns for Systematic Reviews and Meta- Analyses: The PRISMA Statement. PLoS Med 6(7): e1000097. doi:<a href="http://dx.doi.org/10.1371/journal.pmed1000097" target="_blank">10.1371/journal.pmed1000097</a> For more information, visit <a href="http://www.prisma-statement.org" target="_blank">www.prisma-statement.org</a>.</p

Characteristics of Included Studies for MetaAnalysis.

<p>Characteristics of Included Studies for MetaAnalysis.</p