Comparative Efficacy of PD-1 Inhibitor-Based Neoadjuvant Chemoimmunotherapy Regimens for Resectable Stage II-IIIa...

Area of Science:

• Oncology
• Immunotherapy
• Thoracic Surgery

Background:

• Neoadjuvant chemoimmunotherapy is a key treatment for resectable non-small cell lung cancer (NSCLC).
• Real-world comparative data on different PD-1 inhibitors in this setting are limited.
• This study addresses this gap by comparing four PD-1 inhibitors.

Purpose of the Study:

• To compare the clinical efficacy, pathological response, survival outcomes, and safety of four PD-1 inhibitors (pembrolizumab, tislelizumab, camrelizumab, sintilimab).
• To evaluate these agents in patients with resectable Stage II-IIIa NSCLC receiving neoadjuvant therapy.
• To identify potential differences in treatment effectiveness and tolerability.

Main Methods:

• Retrospective review of 199 patients with resectable Stage II-IIIa NSCLC treated with neoadjuvant PD-1 inhibitors plus chemotherapy.
• 149 patients were included after excluding non-surgical cases.
• Outcomes assessed included pathological response (pCR, MPR), recurrence, disease-free survival (DFS), overall survival (OS), and adverse events.

Main Results:

• Pathological complete response (pCR) and major pathological response (MPR) rates varied across PD-1 inhibitors but were not statistically significant.
• Overall survival (OS) was significantly better with pembrolizumab and tislelizumab (p<0.05).
• No significant differences in progression-free survival (PFS) or recurrence were observed among patients achieving pCR. Grade ≥3 treatment-related adverse events were lowest in the tislelizumab group.

Conclusions:

• All evaluated neoadjuvant PD-1 inhibitor regimens achieved substantial pathological responses and had acceptable safety profiles.
• Pembrolizumab and tislelizumab demonstrated superior overall survival and reduced toxicity.
• These findings support the preferential use of pembrolizumab and tislelizumab in neoadjuvant therapy for resectable NSCLC.