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Neoadjuvant Therapy with Immune Checkpoint Inhibitors in Gastric Cancer: A Systematic Review and Meta-Analysis

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Immune checkpoint inhibitors (ICIs) have shown great promise in treating late-stage gastric cancer, but their efficacy in the neoadjuvant setting has not been studied in large cohorts. Here, we explored the efficacy and safety of neoadjuvant ICI-based therapy in locally advanced gastric cancer.

Patients and Methods

We included studies containing patients with locally advanced gastric/gastroesophageal cancer who received ICI-based neoadjuvant therapy. We searched PubMed, Embase, Cochrane library, and abstracts from major international oncology conferences. We performed this meta-analysis using the META package in R.3.6.1.

Results

Twenty-one prospective phase I/II studies comprising 687 patients were identified. The pathological complete response (pCR) rate was 0.21 (95% CI 0.18–0.24), major pathological response (MPR) rate was 0.41 (95% CI 0.31–0.52), and R0 resection rate was 0.94 (95% CI 0.92–0.96). The efficacy was highest with ICI plus radiochemotherapy, lowest with ICI alone, and in the middle with ICI and chemotherapy ± anti-angiogenesis. dMMR/MSI-H and PD-L1-high patients benefited more than pMMR/MSS and PD-L1-low patients. Grade 3 or higher toxicity rate was 0.23 (95% CI 0.13–0.38). These results exceeded those in trials of neoadjuvant chemotherapy, where the rate of pCR was 0.08 (95% CI 0.06–0.11), MPR was 0.22 (95% CI 0.19–0.26), R0 section was 0.84 (95% CI 0.80–0.87), and overall grade 3 or higher toxicity was 0.28 (95% CI 0.13–0.47) in 4800 patients across 21 studies.

Conclusions

In summary, the integrated results show promising efficacy and safety of ICI-based neoadjuvant therapy for locally advanced gastric cancer and support further investigation in large multicenter randomized trials.

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Acknowledgement

Alexandra H. Marshall (Marshall Medical Communications) edited the manuscript. This work was supported by National Natural Science Foundation of China (82173305); Natural Science Foundation of Shandong Province (ZR2017MH005); Foundation of Shandong University Clinical Research Center (2020SDUCRCC011); Chinese Postdoctoral Science Foundation (2019M652406).

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Author notes

  1. Song Li and Qian Xu have contributed equally to this work and share first authorship.

Authors and Affiliations

  1. Department of Medical Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China

    Song Li MD, PhD, Qian Xu MD, Xue Zhang MD, Miao Huang MD, Kai Huang MD, PhD, Jian Wang MD, PhD & Lian Liu MD, PhD

  2. Department of Medical Oncology, Shandong Provincial Hospital of Traditional Chinese Medicine, Jinan, Shandong, China

    Xin Dai MD

  3. Department of Pathology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China

    Duanbo Shi MD, PhD

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  1. Song Li MD, PhD
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Correspondence to Lian Liu MD, PhD.

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Li, S., Xu, Q., Dai, X. et al. Neoadjuvant Therapy with Immune Checkpoint Inhibitors in Gastric Cancer: A Systematic Review and Meta-Analysis. Ann Surg Oncol 30, 3594–3602 (2023). https://doi.org/10.1245/s10434-023-13143-w

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