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

Whether resectable stage II to IIIB non-small cell lung cancer (NSCLC) patients could benefit from adjuvant therapy when pathologic complete response (pCR) is achieved after neoadjuvant immunochemotherapy remains unclear.

We conducted a multicenter retrospective real-world study including patients with resectable stage II to IIIB NSCLC who achieved pCR after neoadjuvant immunochemotherapy and curative-intent resection between January 2020 and December 2023. Patients were categorized according to receipt of adjuvant systemic therapy or surveillance alone. Disease-free survival (DFS) was the primary outcome. Overall survival (OS), cancer-specific survival, recurrence patterns, and treatment-related adverse events (TRAE) were secondary outcomes. Propensity score matching and multivariable Cox regression were used for survival analyses.

Among 214 eligible patients, 133 received adjuvant therapy and 81 underwent surveillance. During a median follow-up of 29.5 months, 25 patients experienced recurrence and 11 died. After propensity score matching, 148 patients (74 per group) were included. In the matched cohort, adjuvant therapy was not associated with improved DFS (pair-stratified hazard ratio [HR] 1.22, 95% confidence interval [CI] 0.51-2.95) or OS (pair-stratified HR 1.00, 95% CI 0.20-4.96) compared with surveillance alone. Recurrence after pCR was predominantly distant. Grade 3 or higher TRAEs were observed in 18% of patients who received adjuvant therapy.

In patients achieving pCR after neoadjuvant immunochemotherapy, adjuvant systemic therapy was not associated with improved survival outcomes compared with surveillance alone and was accompanied by treatment-related toxicity. These findings suggest postoperative surveillance may be an appropriate consideration in discussions of postoperative management after confirmed pCR.