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

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Medical Oncology

Background:

• Renewed interest in resecting Stage III (N2+) non-small cell lung cancer (NSCLC) due to promising outcomes with neoadjuvant/perioperative chemoimmunotherapy (ChIO).
• Focus on reporting surgical outcomes from a clinical trial involving exclusively N2+ NSCLC patients treated with chemotherapy and durvalumab.

Purpose of the Study:

• To evaluate surgical outcomes in patients with resectable Stage III (N2+) NSCLC following neoadjuvant chemotherapy plus durvalumab.
• To assess the feasibility and safety of surgical resection in this challenging patient population.

Main Methods:

• Single-arm, phase II clinical trial conducted across 9 US hospitals.
• Eligible patients received 4 cycles of platinum doublet chemotherapy + durvalumab, followed by lobectomy or greater resection and adjuvant durvalumab for 1 year.
• Analysis included surgical approach, margin status, lymphadenectomy extent, complications, and treatment timeliness.

Main Results:

• 30 out of 37 enrolled patients (81%) underwent resection.
• High R0 resection rate (93.3%), low pneumonectomy rate (6.7%), and short median hospital stay (3.5 days).
• No 30- or 90-day mortality; 63.3% minimally invasive surgery rate; prompt return to adjuvant therapy.

Conclusions:

• Surgical resection following neoadjuvant chemoimmunotherapy (ChIO) for N2+ NSCLC can be safely accomplished with excellent outcomes.
• High rates of R0 resection, minimally invasive surgery, and prompt adjuvant therapy underscore the viability of this approach.
• Resection of N2+ NSCLC after ChIO warrants stronger consideration in multidisciplinary NSCLC treatment strategies.