Surgical Outcomes After Neoadjuvant Chemoimmunotherapy for Resectable Non-Small Cell Lung Cancer

Area of Science:

• Oncology
• Thoracic Surgery
• Immunotherapy

Background:

• Neoadjuvant chemoimmunotherapy is a promising treatment for resectable non-small cell lung cancer (NSCLC).
• Potential challenges include managing inflammatory responses and adverse events that may complicate surgery.
• Assessing the safety and feasibility of this combined approach is crucial for clinical application.

Purpose of the Study:

• To evaluate the safety and feasibility of neoadjuvant chemoimmunotherapy followed by surgical resection in patients with resectable NSCLC.
• To assess the clinical and pathological outcomes of this treatment strategy.
• To identify any treatment-related toxicities and their impact on surgical procedures.

Main Methods:

• Retrospective chart review of 20 patients with stage Ib-IIIb NSCLC who received neoadjuvant chemoimmunotherapy and surgery between May 2019 and March 2021.
• Data collected included demographics, clinical/pathological characteristics, neoadjuvant therapy details, and surgical outcomes.
• Toxicity profiles were assessed retrospectively and via telephone follow-up.

Main Results:

• The study included 20 patients (median age 56, 90% male), predominantly with squamous cell carcinoma (70%).
• All patients received 2-4 cycles of neoadjuvant therapy, with a median of 49 days to surgery.
• Significant findings include major pathologic response in 8 patients (40%), complete pathologic response in 5 (25%), and downstaging in 90%.
• 90% of patients experienced only grade 1-2 adverse effects during neoadjuvant therapy, with no grade 3+ events.
• No perioperative deaths occurred, and 35% experienced postoperative complications; 60% underwent open thoracotomy, 40% minimally invasive surgery without conversion.
• No surgical delays were attributed to immune-related adverse events.

Conclusions:

• Neoadjuvant chemoimmunotherapy followed by surgery is a safe and feasible treatment option for resectable non-small cell lung cancer.
• The regimen demonstrated acceptable toxicity profiles and did not impede surgical intervention.
• Positive pathologic responses and downstaging suggest the potential efficacy of this neoadjuvant strategy.