Neoadjuvant immunochemotherapy in potentially resectable small cell lung cancer: a real-world retrospective analysis

Small cell lung cancer (SCLC) is an aggressive malignancy with limited treatment options. Recent advancements in immunotherapy have shown promise in improving patient outcomes. However, the role of neoadjuvant immunotherapy in potentially resectable SCLC remains unclear. This study aimed to explore the feasibility of neoadjuvant therapy in this population and assess whether the addition of immunotherapy to neoadjuvant therapy further improves the prognosis of limited-stage SCLC (LS-SCLC) patients.

We retrospectively analyzed the medical records of 59 patients with stage IIB-III SCLC who received neoadjuvant therapy followed by surgery at West China Hospital between 2018 and 2024. The patients were divided into two groups: Group A, which included patients who received chemotherapy alone, and Group B, which included patients who received chemotherapy combined with immunotherapy. We evaluated the pathological complete response (pCR) rate, disease-free survival (DFS), and safety profiles of both treatment regimens.

The pCR rate was significantly higher in Group B than Group A (46.9% vs. 11.1%, P=0.006). The median DFS period was also significantly longer in Group B than in Group A (15.3 vs. 11.6 months, P=0.03). All the patients tolerated the treatments well; the adverse events (AEs) were limited to grades 1-2 and were manageable.

Our findings suggest that neoadjuvant immunotherapy combined with chemotherapy followed by surgery may provide a survival benefit over chemotherapy alone in the treatment of resectable SCLC. The combined treatment approach significantly improved the pCR rates and DFS of the patients with resectable SCLC. While our study highlights the potential of this approach, further prospective multi-center studies need to be conducted to validate these findings and explore biomarkers for personalized treatment strategies.