Real-world outcomes of neoadjuvant chemoimmunotherapy in patients with nonsmall cell lung cancer: Predictors of surgery, pathologic complete response, and event-free survival

IF 5.1 2区医学 Q1 ONCOLOGY

Cancer Pub Date : 2025-09-09 DOI:10.1002/cncr.70081

Alissa J. Cooper MD, Edoardo Garbo MD, Andrea Arfe PhD, Michael Conroy MB, BCh, Bao, Narek Shaverdian MD, Matthew Bott MD, Teresa Gorria MD, Federica Pecci MD, Mihaela Aldea MD, PhD, Valsamo Anagnostou MD, PhD, Adam Schoenfeld MD, Daniel Gomez MD, MBA, Patrick M. Forde MBBCh, Mark M. Awad MD, PhD, David R. Jones MD, Biagio Ricciuti MD, PhD, Jamie E. Chaft MD

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Abstract

Background

Trials of neoadjuvant chemoimmunotherapy (chemoIO) have changed the standard of care for resectable nonsmall cell lung cancer (NSCLC). This study characterizes the outcomes of off-trial patients who received treatment with neoadjuvant chemoIO.

Methods

The authors analyzed records of patients with stage IB–III NSCLC who received neoadjuvant chemoIO with an intent to proceed to surgical resection at three US academic institutions. Clinical, demographic, and pathologic factors were incorporated in univariable and multivariable regression models to identify associations with outcomes (resection status, pathologic complete response [pCR], and subsequent event-free survival [EFS]) after standard-of-care neoadjuvant chemoIO.

Results

Analyses included 115 patients, of whom 63% had stage III disease, 77% completed three cycles of chemoIO, and 78% underwent surgical resection. Ages older than 72 years versus 64 years and younger were associated with not proceeding to surgery in univariable (p = .006) and multivariable (p = .014) regression analyses. Nineteen patients (17%) had tumors with a pCR, and 34 (30%) had a major pathologic response. Positive programmed death-ligand 1 (PD-L1) expression (≥50%; vs. negative PD-L1 expression: odds ratio, 12.1; 95% confidence interval, 2.0–73.7; p = .007) and KRAS mutations (vs. wild-type KRAS: odds ratio, 3.9; 95% confidence interval, 1.07–14.4; p = .039) were associated with a higher probability of pCR in univariable analysis. The median event-free survival was not reached and did not differ among subgroups stratified by key clinical variables.

Conclusions

The results from this study confirm the trial experience of high pCR rates after neoadjuvant chemoIO. This supports the use of chemoIO irrespective of KRAS mutation status, PD-L1 expression, and histology, but suggests that this approach may be less suitable for older patients.

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非小细胞肺癌患者新辅助化疗免疫治疗的实际结果：手术、病理完全缓解和无事件生存的预测因素

背景：新辅助化疗免疫治疗（chemoIO）的试验已经改变了可切除的非小细胞肺癌（NSCLC）的治疗标准。本研究描述了接受新辅助化疗治疗的试验外患者的结果。方法：作者分析了在美国三家学术机构接受新辅助化疗并打算进行手术切除的IB-III期非小细胞肺癌患者的记录。将临床、人口学和病理因素纳入单变量和多变量回归模型，以确定标准新辅助化疗后预后（切除状态、病理完全缓解[pCR]和随后的无事件生存[EFS]）的相关性。结果纳入115例患者，其中63%为III期疾病，77%完成3个化疗周期，78%接受手术切除。在单变量回归分析（p = 0.006）和多变量回归分析（p = 0.014）中，年龄大于72岁的患者与64岁及以下的患者不进行手术相关。19例（17%）患者有pCR肿瘤，34例（30%）有主要病理反应。程序性死亡配体1 （PD-L1）阳性表达（≥50%；与PD-L1阴性表达相比：优势比为12.1；95%可信区间为2.0-73.7;p = 0.007）和KRAS突变（与野生型KRAS相比：优势比为3.9；95%可信区间为1.07-14.4;p = 0.039）与单变量分析中较高的pCR概率相关。中位无事件生存期未达到，按关键临床变量分层的亚组间无差异。结论本研究结果证实了新辅助化疗后高pCR率的试验经验。这支持使用chemoIO，而不考虑KRAS突变状态、PD-L1表达和组织学，但表明这种方法可能不太适合老年患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cancer 医学-肿瘤学

CiteScore

13.10

自引率

3.20%

发文量

480

审稿时长

2-3 weeks

期刊介绍： The CANCER site is a full-text, electronic implementation of CANCER, an Interdisciplinary International Journal of the American Cancer Society, and CANCER CYTOPATHOLOGY, a Journal of the American Cancer Society. CANCER publishes interdisciplinary oncologic information according to, but not limited to, the following disease sites and disciplines: blood/bone marrow; breast disease; endocrine disorders; epidemiology; gastrointestinal tract; genitourinary disease; gynecologic oncology; head and neck disease; hepatobiliary tract; integrated medicine; lung disease; medical oncology; neuro-oncology; pathology radiation oncology; translational research