Multicenter retrospective study of real-world results with neoadjuvant chemoimmunotherapy for resectable non-small lung cancer

Neoadjuvant chemoimmunotherapy (NCIT) is being increasingly used in the treatment of resectable non-small cell lung cancer (NSCLC) based on recent randomized controlled trial. The real-world effectiviness of the approach is not clear. A multicenter retrospective study in Alberta (Canada) evaluated early results among patients with stage II-III NSCLC treated with NCIT. Patients received neoadjuvant nivolumab combined with platinum-doublet chemotherapy every 3 weeks for up to 3 cycles. The median duration of follow-up was 7 months. Of 64 patients, 57 (89.1%) completed NCIT and 55 (85.9%) underwent surgery. Major pathologic response was observed in 28 patients (44%; 95% CI 32.3-55.9) and pathologic complete response in 19 (30%; 19.9-41.8). R0 resection was achieved in 54 of 55 patients proceeding to surgery. Adverse events occurred in 45 patients (71.4%) with grade ≥ 3 events in 10 patients (15.6%). Nine patients (14.1%) did not undergo surgery, most often due to disease progression rendering the disease unresectable. Seven patients (12.9%; 95% CI 5.4-20.9) relapsed post-operatively, none of whom had experienced major pathologic response. The authors conclude that in this real-world cohort, NCIT for resectable NSCLC demonstrated response rates comparable to what was reported for pivotal clininal trails; longer follow-up is needed to assess survival outcomes.