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

Area of Science:

• Thoracic Oncology
• Medical Oncology
• Surgical Oncology

Background:

• Neoadjuvant chemoimmunotherapy is increasingly used for stage II to III non-small cell lung cancer (NSCLC).
• Evaluating real-world outcomes, including radiographic response and surgical rates, is essential for treatment optimization.

Purpose of the Study:

• To assess real-world radiographic response and surgical intervention rates in patients with stage II-III NSCLC.
• To analyze the impact of neoadjuvant chemoimmunotherapy on tumor downstaging and surgical eligibility.

Main Methods:

• A prospectively maintained single-institution database of 36 patients with stage II-III NSCLC treated with neoadjuvant chemoimmunotherapy (Jan 2022-July 2024) was evaluated.
• Radiographic response, surgical intervention rates, and reasons for surgery abandonment were recorded.
• Toxicity was graded using standardized criteria (CTCAE for systemic treatment, Clavien-Dindo for surgery).

Main Results:

• An overall response rate (ORR) of 53% was observed, with a median radiographic decrease in tumor diameter of -34%.
• Patients with PD-L1 ≥50% had a higher ORR of 76%.
• The surgical intervention rate was 58% (21/36 patients), with 24% achieving a pathologic complete response. No patients requiring pneumonectomy proceeded to surgery.

Conclusions:

• Neoadjuvant chemoimmunotherapy resulted in a 58% surgical intervention rate at a tertiary care center.
• Radiographic downstaging was common, potentially increasing surgical eligibility.
• Further validation in external cohorts is needed, emphasizing the importance of patient selection for curative surgery.