Real-world Safety and Effectiveness of Neoadjuvant Chemoimmunotherapy in Squamous Cell Lung Cancer: A Retrospective...

Squamous cell lung cancer (SqCLC) accounts for approximately 25% of non-small cell lung cancer (NSCLC). Neoadjuvant chemoimmunotherapy has been established as standard-of-care for resectable NSCLC. Real-world data on safety and effectiveness remain limited.

We conducted a retrospective multicenter cohort study of patients with resectable SqCLC treated with SOC neoadjuvant chemoimmunotherapy across 16 European centers. Primary endpoints were rate of pathological complete response (pCR), major pathological response (MPR), and immune-related adverse events (irAEs) graded per Common Terminology Criteria for Adverse Events v5.0. Secondary endpoints included resection rate and 1-year event-free survival (EFS).

Of 127 patients (69.3% male), 88 were stage III (69.3%). They received a median of 3 chemoimmunotherapy cycles, most commonly carboplatin-paclitaxel-nivolumab (72.4%). Dose reductions and treatment discontinuation occurred in 26 (20.5%) and 10 patients (7.9%), respectively. Seventy-nine patients (62.2%) experienced ≥ 1 AE, including 9 grade 3 irAEs. No chemoimmunotherapy‑related deaths occurred. Objective response rate was 76.8%. Twenty-four patients did not undergo surgery, including 4 due to toxicity; subsequently, 9 received radical radiotherapy. Overall (n = 127), pCR and MPR rates were 41.7% and 63.8%, respectively. Among surgical patients (n = 103), pCR was 51.5% and MPR 78.6%. 1-year EFS rate was 75.6%. Notably, 58.3% of patients who did not proceed to surgery experienced disease progression within 1 year and 37.5% died.

In this European real‑world cohort, neoadjuvant chemoimmunotherapy for resectable SqCLC was feasible, demonstrated manageable toxicity, and achieved high pCR rates. These findings support broader implementation in routine practice and further research into predictors of benefit and long‑term outcomes.