Abstract
BACKGROUND: The effectiveness of different immune checkpoint inhibitors (ICIs) (i.e., pembrolizumab or sintilimab) in combination with chemotherapy in the treatment of resectable non-small cell lung cancer (NSCLC) is unknown. Using propensity score matching (PSM), this study aimed to analyze the preliminary results of using neoadjuvant chemotherapy in combination with sintilimab or pembrolizumab in the treatment resectable NSCLC. METHODS: NSCLC patients who received neoadjuvant pembrolizumab or sintilimab in combination with chemotherapy at two hospitals between June 2018 and March 2024 were recruited for the study. PSM was used to analyze the differences between the two groups in terms of the objective response rate (ORR), pathological complete response (pCR) rate, and operation-related information. RESULTS: A total of 366 patients were enrolled in the study: 163 in the sintilimab group (SG) and 203 in the pembrolizumab group (PG). Of the patients, 159 (43.4%) achieved a pCR, of whom 70 (42.9%) and 89 (43.8%) belonged to the SG and PG, respectively (P=0.86). No significant differences were observed between the SG and PG in terms of the major pathological response (MPR) rate (108, 66.3% vs. 127, 62.5%, P=0.46) and ORR (116, 71.2% vs. 126, 62.1%, P=0.07). The logistic analyses indicated that treatment with ≥3 cycles of neoadjuvant treatment and squamous cell cancer remained significant promoting factors of pCR. After PSM, the pCR rate and ORR were also similar between the SG and PG (63 of 140, 45.0% vs. 63 of 140, 45.0%, P>0.99; 93 of 140, 66.4% vs. 82 of 140, 58.6%, 17.1%). The 1- and 3-year overall survival (OS) rates of the PG were 98.7% and 79.3%, while those of the SG were 98.1% and 75.6% (P=0.73). After PSM, the 1- and 3-year OS rates of the PG were 95.3% and 77.0%, while those of the SG were 98.8% and 79.4%, respectively (P=0.22). CONCLUSIONS: The combination of sintilimab or pembrolizumab with chemotherapy demonstrated similar effectiveness in terms of achieving a pCR in the neoadjuvant treatment of resectable NSCLC, and yielded comparable treatment outcomes.