Surgical and Pathological Results Following Neoadjuvant Nivolumab and Platinum-Based Chemotherapy for Locally Advanced Resectable NSCLC: A Multicentre Real-World Series From England

Abstract

Background: To evaluate the real-world surgical and pathological outcomes following neoadjuvant nivolumab in combination with chemotherapy in a multicentre national cohort of patients.

Methods: Retrospective analysis on consecutive patients treated in three tertiary referral hospitals in UK with neoadjuvant chemotherapy and immunotherapy (nivolumab) for stage II-IIIB nonsmall cell lung cancer (March 2023-May 2024). Surgical and pathological outcomes were assessed.

Results: 130 patients started neoadjuvant treatment. 121 patients (93.1%) were able to proceed to surgery. 62% of patients had surgery more than 6 weeks after completion of the last neoadjuvant cycle. 91 operations (75.2%) were started using a minimally invasive approach with a conversion rate of 18.7%. The most frequent resection was lobectomy in 85% of patients. 30- and 90-days postoperative mortality rates were 3.3% and 5.8%. The pCR occurred in 38 patients (31.4% of the surgical patients), MPR in 57 patients (47.1% of the surgical patients). The incidence of pCR (P = .90) and MPR (P = .66) were similar in patients with clinical stage II and III. pCR rate was higher in patients with PD-L1 ≥50% compared to those with PD-L1 <50% (41.9% vs. 25.6%, P = .066). A higher pCR (44.7% vs. 23%, P = .012) and MPR (66% vs. 35.1%, P = .001) in squamous vs. non-squamous histology tumors.

Conclusions: The use of neoadjuvant chemo-ICI in the real clinical practice is safe and effective. The pathological response rates parallel those reported in trials and appear consistent across stages. Our findings provide real world data from a public healthcare system which will be valuable to inform multidisciplinary treatment selection for locally advanced resectable NSCLC.

Keywords: Chemotherapy; Immunotherapy; Lung cancer; Outcome; Surgery.