Real World Radiographic Response Rates and Preoperative Attrition in Patients With Non-Small Cell Lung Cancer (NSCLC)...

To evaluate real-world rates of radiographic response and surgery in patients treated with neoadjuvant chemoimmunotherapy for stage II to III NSCLC.

We evaluated a prospectively maintained single-institution database of patients of stage II to III NSCLC treated with neoadjuvant chemoimmunotherapy from January 2022 to July 2024. Rates of radiographic response, surgery, and reasons for abandoning surgery were recorded. Toxicity was graded according to the Common Terminology Criteria for Adverse Events for systemic treatment and the Clavien-Dindo Scale for surgery.

Overall, 1243 patients were screened: 323 had stage II-III NSCLC that could be treated with curative intent, of whom 111 were considered eligible for surgery and 36 were treated with neoadjuvant chemoimmunotherapy, which will reflect the remainder of this report. The overall response rate (ORR) was 53% and median radiographic change in the sum of tumor diameter was -34% (IQR -44 to -11). In patients with PD-L1 ≥50%, the ORR was 76%. Most patients had evidence of radiographic downstaging after neoadjuvant treatment. The rate of surgical intervention was 58% (n=21). No patient thought to require a pneumonectomy before neoadjuvant therapy underwent surgery. Pathologic complete response rate was seen in 5 of the 21 patients (24%). There were 42 adverse events from chemoimmunotherapy and 19 from surgery, of which 12% and 11% were grade 3 or higher, respectively.

At a tertiary care center, the rate of surgical intervention after neoadjuvant chemoimmunotherapy was 58%. These results require further validation in additional external cohorts and highlight the need for optimal patient selection to ensure the use of curative surgery.