Neoadjuvant therapy in early-stage non-small cell lung cancer: A real-world analysis

Abstract

Background: Phase 3 trials of neoadjuvant immunotherapy-based regimens have shown promising outcomes in patients with resectable non-small cell lung cancer (NSCLC). However, real-world data on treatment regimens with combined chemoimmunotherapy, patient profiles, and clinical outcomes in those patients are limited.

Methods: This dual-center registry-based study describes clinical patterns and outcomes of using neoadjuvant platinum-based chemoimmunotherapy in patients with resectable NSCLC. The main objective was to evaluate the proportion of patients receiving local therapy after chemoimmunotherapy. Further objectives include pathological outcome, disease-free survival (DFS), and overall survival (OS). Histological samples underwent next-generation sequencing (NGS).

Results: Seventy-two patients (median age 64.5 years (interquartile range (IQR), 59-69); 40.3 % women) were included. Prior to initiation of therapy, NGS was available in 90.3 %. Median follow-up time from date of diagnosis was 374 days (IQR, 241-605). After neoadjuvant therapy, 46 patients underwent surgery and 23 radiotherapy, resulting in 69 patients receiving local therapy. Out of 46 patients who underwent surgery, 22 had pathological complete remission (PR), 11 major PR, and 12 minor PR. DFS (95 % confidence interval (CI)) in 43 (out of 46) surgical patients with R0 resection was 98 % (93-100), 98 % (93-100) and 81 % (57-100) after 180, 360 and 720 days, respectively. OS (95 % CI) was 97 % (94-100), 90 % (82-99) and 90 % (82-99), after 180, 360 and 720 days, respectively.

Conclusion: Following neoadjuvant chemoimmunotherapy, the majority of resectable early-stage NSCLC patients could undergo local therapy in routine clinical practice. This was associated with favorable DFS and OS.

Keywords: Chemoimmunotherapy; Consolidation therapy; NSCLC; Neoadjuvant therapy; Resection rate; Surgery; Survival.