What's the optimal duration of neoadjuvant chemoimmunotherapy for resectable non-small cell lung cancer: a real-world study.

Abstract

Objectives: The optimal duration of neoadjuvant chemoimmunotherapy for resectable non-small cell lung cancer remains unknown. This study aimed to assess whether the number of cycles of neoadjuvant therapy affects oncologic efficacy and surgical safety in a real-world setting.

Methods: Patients with resectable non-small cell lung cancer who received neoadjuvant chemoimmunotherapy and subsequent surgery were included. Patients were divided into two groups: ≤ 2 or > 2 cycles. Oncology outcomes such as pathological complete response (pCR), and surgical outcomes were compared. Binary logistic regression analyses were conducted to identify independent factors for pCR. Kaplan-Meier analysis was used to compare long-term survival between groups. Cox regression analyses were conducted to identify independent predictors for recurrence.

Results: A total of 140 patients with clinical stage IB-IIIB disease were included; 68 received ≤ 2 cycles, and 72 received > 2 cycles of neoadjuvant chemoimmunotherapy. No significant difference was observed in pCR rates, surgery difficulty, and postoperative complications between groups. Multivariate binary logistic regression analysis indicated that adenocarcinoma (odds ratio [OR] 0.14, 95% confidence interval [CI] 0.04-0.50, P = 0.003) and clinical T3 stage (OR 0.18, 95% CI 0.05-0.72, P = 0.015) were unfavourable factors for pCR. Kaplan-Meier survival analysis revealed no significant difference in recurrence-free survival (RFS) or overall survival (OS) between groups. Multivariate Cox regression analysis revealed that number of neoadjuvant cycles was not a predictor of recurrence (HR 0.87, 95% CI 0.31-2.44, P = 0.8).

Conclusions: Compared with 3 or more cycles, two cycles of neoadjuvant chemoimmunotherapy might achieve similar perioperative outcomes and long-term survival in selected patients. Prospective studies and extended follow-up are needed to verify the conclusions.