Neoadjuvant Chemoimmunotherapy for Locally Advanced NSCLC: Who May Benefit?

By: Chris Schimpf, BS
Posted: Thursday, February 1, 2024

The findings of a study published in BMC Cancer suggest that chemoimmunotherapy may be a safe and feasible treatment regimen for patients with N1/N2 lymph node–positive, non–small cell lung cancer (NSCLC). Zhengliang Tu, PhD, MD, of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China, and colleagues found that older patients and those with squamous cell carcinoma treated with this approach seemed to have better pathologic response; they also learned that multiple nodal metastases were a negative predictor. Finally, they said, lymph node clearance after neoadjuvant chemoimmunotherapy resulted in significantly longer progression-free and overall survival.

“Our data support the role of the pathological response as a potential survival surrogate,” the investigators noted. “[Also], no additional surgical complications attributed to the neoadjuvant treatment were observed. Our data indicated the patients could safely undergo operations after neoadjuvant chemoimmunotherapy.”

A total of 75 patients with N1/N2-stage resectable NSCLC who received neoadjuvant chemoimmunotherapy plus surgery were included in the retrospective study. The researchers analyzed correlations between major pathologic response and pathologic complete response, and they evaluated progression-free and overall survival with pathologic response and nodal status.

Among the participants, 92% experienced treatment-related adverse effects, with grade 3 or 4 adverse effects reported in 10% of patients. All patients had surgical R0 resection, with a major pathologic response rate of 60% and a pathologic complete response rate of 36%. The investigators observed a significant difference in pathologic response with age, histology, and multiple lymph node metastasis. They also reported that lymph node clearance occurred in 67% of patients with N1 disease and 77% of patients with N2 disease after neoadjuvant treatment. Progression-free survival rates were 90.1% at 12 months and 83.6% at 18 months among patients who experienced lymph node clearance, compared with 70.1% and 63.7%, respectively, among those who did not.

Disclosure: The study authors reported no conflicts of interest.

BMC Cancer

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