Efficacy of neoadjuvant chemo-immunotherapy in non-small cell lung cancer: a real-world, multicenter, retrospective study

Xun Wang; Xin Wang; Bengang Hui; Jingsheng Cai; Heng Zhao; Bowei Qiao; Jiangnan Duan; Kezhong Chen; Jun Wang; Jie Lei; Fan Yang

doi:10.21037/tlcr-24-17

Efficacy of neoadjuvant chemo-immunotherapy in non-small cell lung cancer: a real-world, multicenter, retrospective study

Transl Lung Cancer Res. 2024 Apr 29;13(4):849-860. doi: 10.21037/tlcr-24-17. Epub 2024 Apr 18.

Authors

Xun Wang^#^{1

2}, Xin Wang^#^{1

2}, Bengang Hui^#³, Jingsheng Cai^{1

2}, Heng Zhao^{1

2}, Bowei Qiao³, Jiangnan Duan³, Kezhong Chen^{1

2}, Jun Wang^{1

2}, Jie Lei³, Fan Yang^{1

2}

Affiliations

¹ Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China.
² Thoracic Oncology Institute, Peking University People's Hospital, Beijing, China.
³ Department of Thoracic Surgery, The Second Affiliated Hospital of Air Force Medical University, Xi'an, China.

^# Contributed equally.

Abstract

Background: Resectable non-small cell lung cancer (NSCLC) patients have a high risk of recurrence. Multiple randomized controlled trials (RCTs) have shown that neoadjuvant chemo-immunotherapy brings new hope for these patients. The study aims to evaluate the safety, surgery-related outcomes and oncological outcomes for neoadjuvant chemo-immunotherapy in real-world setting with a large sample size and long-term follow-up.

Methods: Patients with clinical stage IB-IIIB NSCLC who received neoadjuvant chemo-immunotherapy at two Chinese institutions were included in this retrospective cohort study. Surgical and oncological outcomes of the enrolled NSCLC patients were collected and analyzed.

Results: There were 158 patients identified, of which 124 (78.5%) were at stage IIIA-IIIB and the remaining 34 (21.5%) were at stage IB-IIB. Forty-one patients (25.9%) received two cycles of neoadjuvant treatment, 80 (50.6%) had three cycles, and 37 (23.4%) had four cycles. Twenty-four patients (15.2%) experienced grade 3 or worse immune-related adverse events. The median interval time between the last neoadjuvant therapy and surgery was 37 [interquartile range (IQR), 31-43] days. Fifty-eight out of 96 (60.4%) central NSCLC patients who were expected to undergo complex surgery had the scope or the difficulty of operation reduced. Ninety-five (60.1%) patients achieved major pathologic response (MPR), including 62 (39.2%) patients with pathologic complete response (pCR). Multivariate regression analysis showed that no clinical factor other than programmed death-ligand 1 (PD-L1) expression was predictive of the pathological response. The median follow-up time from diagnosis was 27.1 months. MPR and pCR were significantly associated with improved progression-free survival (PFS) and overall survival (OS). Neither stage nor PD-L1 expression was significantly associated with long-term survival.

Conclusions: The neoadjuvant chemo-immunotherapy is a feasible strategy for NSCLC with a favorable rate of pCR/MPR, modified resection and 2-year survival. No clinical factor other than PD-L1 expression was predictive of the pathological response. pCR/MPR may be effective surrogate endpoint for survival in NSCLC patients who received neoadjuvant chemo-immunotherapy.

Keywords: Non-small cell lung cancer (NSCLC); chemo-immunotherapy; neoadjuvant therapy; programmed death-1/programmed death-ligand 1 (PD-1/PD-L1); surgical extent.