CHIO3: CHemotherapy Combined with Immune Checkpoint Inhibitor for Operable Stage IIIA/B (N2) Non-Small Cell Lung...

There is renewed interest in resection of Stage III (N2+) NSCLC given impressive outcomes with neoadjuvant/perioperative chemoimmunotherapy (ChIO). We report surgical outcomes from an exclusively N2+ NSCLC clinical trial following chemotherapy + durvalumab.

This was a single arm phase II trial enrolled at 9 US hospitals. Eligible patients had resectable stage III NSCLC, pathologically proven N2+. Patients received 4 cycles of platinum doublet + durvalumab followed by lobectomy or greater, and adjuvant durvalumab for 1 year. Surgical approach, margins, extent of lymphadenectomy, complications, and treatment timeliness were analyzed.

From 2021-2023, 37 patients were enrolled; 30 patients underwent resection (81%). Surgical outcomes are notable for R0 resection in 28/30 patients (93.3%), pneumonectomy rate of 6.7% (2/30), median stay 3.5 days, no mortality at 30 and 90 days. Minimally invasive surgery was possible in 19/30 (63.3%: 2 VATS, 17 robotic), with 2 conversions to thoracotomy (total thoracotomy rate: 11/30: 36.7%). Increased surgical difficulty was reported in 14/30 (46.7%). Median interval from neoadjuvant therapy to surgery was 46 days, and from surgery to adjuvant therapy was 35 days. All 23 patients recommended for adjuvant therapy received it.

This trial provides insight into surgical outcomes for prospectively documented N2+ NSCLC treated with neoadjuvant ChIO. Surgery in this challenging scenario was accomplished with no mortality, high rates of minimally invasive surgery, R0 resection, and lobectomy, with prompt return to oncologic therapy. Following ChIO, resection of N2+ NSCLC can be achieved with excellent outcomes and warrants stronger consideration within multidisciplinary NSCLC care.