Adjuvant Therapy After Pathologic Complete Response to Neoadjuvant Immunochemotherapy in Non-Small Cell Lung Cancer:...

Area of Science:

• Oncology
• Thoracic Surgery
• Clinical Trials

Background:

• Investigating adjuvant therapy benefits in resectable non-small cell lung cancer (NSCLC) patients with pathologic complete response (pCR) after neoadjuvant immunochemotherapy.
• Uncertainty surrounds the efficacy of adjuvant treatments post-neoadjuvant therapy in achieving pCR for NSCLC.

Purpose of the Study:

• To evaluate the impact of adjuvant systemic therapy versus surveillance on survival outcomes in resectable stage II to IIIB NSCLC patients who achieved pCR post-neoadjuvant immunochemotherapy.
• To analyze recurrence patterns and treatment-related adverse events (TRAE) associated with adjuvant therapy in this patient cohort.

Main Methods:

• Multicenter retrospective real-world study of 214 NSCLC patients (Stage II-IIIB) achieving pCR after neoadjuvant immunochemotherapy and resection (Jan 2020-Dec 2023).
• Patients were grouped into adjuvant therapy or surveillance arms.
• Propensity score matching and multivariable Cox regression analyses were employed to compare disease-free survival (DFS) and overall survival (OS).

Main Results:

• After propensity score matching (74 patients per group), adjuvant therapy showed no significant improvement in DFS (HR 1.22, 95% CI 0.51-2.95) or OS (HR 1.00, 95% CI 0.20-4.96) compared to surveillance.
• Recurrences observed post-pCR were predominantly distant.
• Grade 3 or higher TRAEs occurred in 18% of patients receiving adjuvant therapy.

Conclusions:

• Adjuvant systemic therapy following neoadjuvant immunochemotherapy in NSCLC patients who achieve pCR does not appear to enhance survival outcomes.
• Adjuvant therapy is associated with significant treatment-related toxicity.
• Postoperative surveillance should be considered a viable management strategy for patients with confirmed pCR.