Immunotherapy-Based Neoadjuvant Regimens Show Promise for Locally Advanced Gastric Cancer

A recent meta-analysis published in the International Journal of Surgery has revealed new insights into the efficacy and safety of immunotherapy-based neoadjuvant regimens for locally advanced gastric cancer (LAGC). The study, conducted by a team of researchers from Capital Medical University in Beijing, China, aimed to evaluate the antitumor effects of three distinct immunotherapy-based regimens: neoadjuvant immunotherapy plus chemotherapy (NICT), neoadjuvant chemotherapy plus targeted therapy (NCTT), and NICT plus targeted therapy (NICTT).

Key Takeaways:

• The pooled results from single-arm studies indicated that immune-based neoadjuvant therapy could increase the rates of pathological complete response (pCR), severe treatment-related adverse events (TRAEs), 1- and 3-year disease-free survival (DFS), and 1- and 3-year overall survival (OS) to 20%, 30%, 91%, 74%, 94%, and 81%, respectively.
• Pairwise meta-analysis indicated that both the NICT and NICTT groups achieved higher rates of pCR, major pathological response (MPR), and complete resection (R0 resection) compared to the neoadjuvant chemotherapy (NCT) group.
• The NICTT group exhibited a significantly higher risk of experiencing severe TRAEs compared to the NCT group.
• ICIs + XELOX appeared to be a more appropriate NICT regimen, as it effectively enhanced the tumor response rate while inducing less severe TRAEs.
• Tumors exhibiting positive expression of PD-L1 or microsatellite instable (MSI) demonstrated a higher level of responsiveness to the NICT regimen.
• Immunotherapy-based neoadjuvant regimens exhibit an enhanced potential for promoting tumor regression; however, caution is warranted due to the elevated risk of severe TRAEs.

Statistics:

• 16 high-quality Phase II prospective single-arm clinical studies and 7 dual-arm clinical studies were selected for the meta-analysis.
• The pooled results from the single-arm studies indicated a pCR rate of 20%, TRAE rate of 30%, DFS rate of 91%, OS rate of 74%, 94%, and 81% for 1- and 3-year survival.
• The NICTT group experienced a significantly higher risk of severe TRAEs compared to the NCT group.

Sources:

• Efficacy and safety of immunotherapy-based neoadjuvant regimens in locally advanced gastric cancer: a meta-analysis based on high-quality clinical trials. International Journal of Surgery, 2025;111(10):7222-7235.
• NewsRx. Studies from Capital Medical University Reveal New Findings on Gastric Cancer (Efficacy and safety of immunotherapy-based neoadjuvant regimens in locally advanced gastric cancer: a meta-analysis based on high-quality clinical trials). Immunotherapy Weekly. October 29, 2025; p 2344.