A-meta-analysis Of Neoadjuvant EGFR-TKIs And Neoadjuvant Chemotherapy For Patients With Non-small Cell Lung Cancer

Background and purpose:Lung cancer is now a major threat to human health.According to the 2018 global cancer statistics,lung cancer incidence rate and death rate ranked first among all the malignant tumors in the world,and about 80%of the new ones are Non-small Cell Lung Cancer NSCLC(Non-Small Cell Lung Cancer)[Although the rapid progress of cancer treatment has improved the prognosis of stage Ⅰ-Ⅲ NSCLC,while 30-60%of patients still progress to metastatic disease.It is a pity no matter for the clinicians or patients themselves.For resectable NSCLC patients,surgical resection is the current standard treatment,but for unresectable tumor patients,traditional adjuvant therapy such as chemotherapy or radiotherapy is still not satisfactory.It has shown that the median survival of stage Ⅲ A patients with traditional treatment is 14 months,while the median overall survival of patients with metastatic NSCLC is about 12 months,and the 5-year survival rate is only 1%.Therefore,a variety of new treatment strategy is urgently needed to slow the development of unresectable diseases due to advanced stage,increase the chance of surgical resection,reduce postoperative recurrence,improve overall survival,and extend the length and improve the quality of patients’ life.In the 20th century,experienced clinicians put forward the new concept of "neoadjuvant therapy" through many years of rich clinical experience and long-term scientific research that is to make patients receive chemotherapy or radiotherapy before surgery to reduce the volume of the tumor and create chances for surgical resection.Under the effect of neoadjuvant therapy,the circulating tumor cells in the patient are eliminated before operation,which can reduce the stage of the tumor and make patients obtain long-term survival benefits.Nowadays,the emergence of targeted drugs has opened a new era of cancer treatment.There are many studies on targeted drug adjuvant therapy,but few comparative studies on neoadjuvant targeted therapy and neoadjuvant chemotherapy.The purpose of this study is to compare the efficacy and safety of neoadjuvant targeted therapy and neoadjuvant chemotherapy in NSCLC therapy through Meta-analysis to provide support for the wide application of neoadjuvant targeted therapy in the future.Method:Use of PubMed、Embase and Cochrane Library、CNKI、WanFang Date、CNKI、CBM.A comprehensive English and Chinese search was conducted to identify published articles on NSCLC neoadjuvant targeted therapy reported before January 1,2021.At the same time,a search for unpublished latest data of clinical trials of neoadjuvant targeted therapy in NSCLC in the international oncology conferences such as ASCO(American Society of Clinical Oncology)and ESMO(European Society of Medical Oncology)up to January 1,2021 was conducted.Search with non-small cell lung cancer(including lung adenocarcinoma,lung large cell carcinoma,lung squamous cell lung cancer),targeted therapy(covering all currently known gene mutation sites)and neoadjuvant therapy as the main title.Two reviewers independently screened the articles,extracted the data and assessed the biased risk,used Rev Man 5.4 for Meta-analysis.Results:Six clinical studies including 452 patients were included.Meta-analysis showed that:Compared with neoadjuvant chemotherapy,neoadjuvant targeted therapy has obvious benefits in objective remission rate[OR=2.37 95%CI 1.61-3.48]and pathological reduction rate[OR=1.94 95%CI 0.58-6.52].There was no significant difference in pCR and the benefit results were disappointing.In terms of safety,grade 3/4 toxic side effects[OR=0.12 95%CI 0.02-0.88],surgical complication related rate[OR=1.05 95%CI 0.60-1.84],surgical resection rate[OR=1.88 95%CI 0.97-3.65],and radical resection rate[OR=1.42 95%CI 0.76-2.63]were also significantly benefited.The delay rate of both two was consistent and the feedback was good.However,in the treatment of adverse events[OR=1.36 95%CI 0.39-4.97],neoadjuvant chemotherapy was less common.Conclusion:Combined with the existing evidence,neoadjuvant targeted therapy is safer and more effective compared with neoadjuvant chemotherapy in the treatment of NSCLC,though it is still controversial that neoadjuvant targeted therapy is more effective than neoadjuvant chemotherapy.In general,this study is to support the further clinical application of neoadjuvant targeted therapy.