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Dropout after Neoadjuvant Chemoimmunotherapy for Non-Small Cell Lung Cancer in the Veterans Health Administration
Whitney S Brandt1, Daniel B Eaton2, Nahom Seyoum1
1Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO USA.
The Annals of Thoracic Surgery
|August 5, 2026
Summary
Advanced non-small cell lung cancer patients receiving chemoimmunotherapy before surgery show good survival. However, nearly a third don't have surgery, often due to progression, highlighting a need for better management strategies.
Area of Science:
- Oncology
- Thoracic Surgery
- Cancer Research
Background:
- Induction chemoimmunotherapy followed by surgery improves survival in advanced non-small cell lung cancer (NSCLC).
- Limited data exists on treatment uptake, utilization, and dropout rates in the Veterans Health Administration (VHA) cohort.
- Understanding reasons for not proceeding to surgery is crucial for optimizing treatment pathways.
Purpose of the Study:
- To describe the utilization of induction chemoimmunotherapy (CIO) in advanced NSCLC patients within the VHA.
- To analyze factors contributing to patients not undergoing surgical resection after CIO.
- To evaluate overall survival (OS) in this cohort.
Main Methods:
- Retrospective analysis of VHA database for patients with clinical stage IB-III-N2 NSCLC receiving CIO (2021-2024).
- Inclusion criteria: at least 2 cycles CIO; exclusion criteria: radiation during CIO, N3 disease, >4 cycles CIO, or cStage IV disease.
- Kaplan-Meier method used for overall survival estimation.
Main Results:
- 86 patients met inclusion criteria; 60 (69.8%) underwent surgery, 26 (30.2%) did not.
- Groups were similar in clinical stage, age, and comorbidities.
- Disease progression (distant metastasis) occurred in 46.2% of patients not undergoing surgery.
- 2-year OS was 80.2% overall (86.7% surgical vs. 65.8% non-surgical).
Conclusions:
- Induction chemoimmunotherapy with surgical intent is associated with favorable intermediate-term survival in advanced NSCLC.
- Nearly one-third of patients did not undergo surgery, primarily due to disease progression.
- Further research is needed to identify patients at risk of progression and develop alternative management strategies.
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