Induction immune-checkpoint inhibitors for resectable oncogene-mutant NSCLC: A multicenter pooled analysis

Area of Science:

• Oncology
• Immunotherapy
• Thoracic Surgery

Background:

• Immunotherapy efficacy in advanced non-small cell lung cancer (NSCLC) with driver mutations is limited.
• The potential clinical value of neoadjuvant immunotherapy in this patient population requires further investigation.

Purpose of the Study:

• To evaluate the clinical efficacy and feasibility of neoadjuvant immunotherapy in patients with resectable oncogene-mutant NSCLC.
• To assess pathological response rates, resection margins, and survival outcomes.
• To explore predictive biomarkers for neoadjuvant immunotherapy response.

Main Methods:

• Retrospective analysis of 40 patients with oncogene-mutant NSCLC treated with induction immunotherapy.
• Evaluation of overall response rate (ORR), R0 resection rate, major pathological response (MPR), and pathological complete response (pCR).
• Indirect comparison with historical data (CTONG1103 cohort) for neoadjuvant immunotherapy plus chemotherapy in EGFR-mutant NSCLC.

Main Results:

• An overall response rate of 62.5% was observed, with a high R0 resection rate of 97.4% in 39 surgically treated patients.
• Major pathological response (MPR) was achieved in 37.5% and pathological complete response (pCR) in 12.5% of patients.
• Pre-treatment PD-L1 expression did not predict response. Median disease-free survival was 28.5 months for all oncogenic mutations and EGFR mutations.

Conclusions:

• Neoadjuvant immunotherapy demonstrates potential clinical feasibility for resectable localized oncogene-mutant NSCLC, particularly EGFR-mutant NSCLC.
• Neoadjuvant immunotherapy plus chemotherapy may offer superior efficacy compared to erlotinib and chemotherapy for resectable EGFR-mutant NSCLC.
• Further research is needed, especially for uncommon EGFR mutations where MPR was not observed with neoadjuvant chemoimmunotherapy.