Association between treatment-related adverse events and clinical outcomes in NSCLC patients receiving neoadjuvant...

This study investigated the association between treatment-related adverse events (TRAEs) and clinical outcomes, including pathological response and event-free survival (EFS), in patients with resectable non-small cell lung cancer (NSCLC) receiving neoadjuvant anti-PD-1 immuno-chemotherapy.

In this retrospective study, 176 patients receiving neoadjuvant PD-1 inhibitors plus chemotherapy (April 2020-August 2023) were analyzed to evaluate the relationships between TRAEs and two predefined clinical outcomes: pathological responses and EFS, in both overall and inverse probability of treatment weighting (IPTW)-adjusted cohorts.

TRAEs occurred in 81.8% of patients, while Immune-related adverse events (irAEs) were observed in 18.2%. After IPTW, myelosuppression, the most common TRAE, occurred in 78 patients, had significantly higher rates of non-major pathological response (NMPR) (53.8% vs. 32.1%; odds ratio 2.46, 95% CI: 1.33-4.58; p < 0.01). Among patients with irAEs, rash/pruritus occurred in 20 patients, with a higher major pathological response (MPR) rate (79.8% vs.53.8%; odds ratio 0.29, 95% CI: 0.09-0.92; p = 0.049). Kaplan-Meier analysis showed that both TRAEs (p = 0.016) and myelosuppression (p = 0.044) were associated with significantly worse EFS. Rash/pruritus was closely associated with a higher MPR rate, but no significant difference was observed in EFS analysis due to the limited number of patients (p = 0.884). PD-1 inhibitor type showed no significant association with EFS (p > 0.05), although tislelizumab was linked to higher rates of fever (p = 0.001) and Hepatic dysfunction (p = 0.038).​.

Myelosuppression is negatively associated with favorable pathological outcomes in NSCLC patients undergoing neoadjuvant immunochemotherapy and serves as a potential predictor of EFS, offering valuable insights for guiding treatment decisions.