Neoadjuvant Chemotherapy-Immunotherapy in Non-Small Cell Lung Cancer: Can Positron Emission Tomography Scan Predict...

Area of Science:

• Thoracic Oncology
• Medical Imaging
• Immunotherapy

Background:

• Neoadjuvant chemotherapy and immunotherapy (chemo-IO) offers survival benefits for operable non-small cell lung cancer (NSCLC).
• Real-world data on chemo-IO effectiveness in NSCLC is limited, hindering clinical trial reproducibility assessment.

Purpose of the Study:

• To evaluate the real-world safety and efficacy of neoadjuvant chemo-IO in patients with stage II-III NSCLC.
• To identify potential imaging biomarkers for predicting treatment response.

Main Methods:

• Retrospective analysis of NSCLC registries and thoracic surgery databases from two Canadian centers.
• Inclusion of 78 patients with stage II-III NSCLC receiving at least one cycle of neoadjuvant chemo-IO.
• Kaplan-Meier survival analysis and ROC curve analysis for predicting pathologic complete response (pCR) based on standardized uptake value (SUV) reduction.

Main Results:

• 54% of patients experienced adverse events from chemo-IO (47% grade 1-2, 14% grade 3).
• Pathologic complete response (pCR) rate was 24%.
• A 70% reduction in maximal SUV on PET scans significantly correlated with pCR (AUC=0.89, P=.01), particularly in patients with PD-L1 TPS ≥50%.

Conclusions:

• Neoadjuvant chemo-IO is safe and demonstrates short-term efficacy in a real-world NSCLC cohort.
• SUV reduction on PET scans shows potential as a surrogate biomarker for pCR in NSCLC patients receiving chemo-IO, warranting further validation.