Comparative Efficacy of PD-1 Inhibitor-Based Neoadjuvant Chemoimmunotherapy Regimens for Resectable Stage II-IIIa NSCLC: A Real-World Retrospective Study.

Background: Although neoadjuvant chemoimmunotherapy has emerged as a promising approach for resectable non-small cell lung cancer (NSCLC), comparative real-world data on different PD-1 inhibitors are limited. This study compared the clinical efficacy, pathological response, survival, and safety of four PD-1 inhibitors-pembrolizumab, tislelizumab, camrelizumab, and sintilimab-in patients with Stage II-IIIa NSCLC.

Methods: We retrospectively reviewed 199 patients with resectable Stage II-IIIa NSCLC treated with neoadjuvant PD-1 inhibitors plus platinum-based chemotherapy from January 2018 to December 2024. After excluding 50 non-surgical cases, 149 patients were included. Outcomes compared included pathological response (pathological complete response, pCR; major pathological response, MPR), recurrence, disease-free survival (DFS), overall survival (OS), and adverse events.

Results: pCR and MPR rates were 52.2% and 58.0% (pembrolizumab), 67.6% and 75.7% (tislelizumab), 71.4% and 71.4% (camrelizumab), and 47.2% and 61.1% (sintilimab), respectively. Differences in pCR/MPR were not statistically significant. However, OS differed significantly across groups (p < 0.05), favoring pembrolizumab and tislelizumab. No significant differences were observed in progression-free survival (PFS) or recurrence among patients with pCR. Grade ≥ 3 treatment-related adverse events occurred in 27.0%-42.9% of patients, lowest in the tislelizumab group.

Conclusion: All treatment regimens elicited substantial pathological responses and exhibited acceptable safety profiles. Pembrolizumab and tislelizumab were associated with better OS and lower toxicity, supporting their preferential use in neoadjuvant therapy for resectable NSCLC.