Outcomes of Resectable Locally Advanced Non-Small Cell Lung Cancer After Neoadjuvant Chemoimmunotherapy: A Single Institution Experience

Abstract

Introduction: Immunotherapy has revolutionized the treatment for locally advanced resectable non-small-cell lung cancer (NSCLC). In clinical trials, the combination of neoadjuvant immunotherapy and chemotherapy has resulted in a higher rate of pathologic complete response in comparison with neoadjuvant chemotherapy alone. Our study aims to describe surgical and oncological outcomes after neoadjuvant chemoimmunotherapy and lung resection at our academic center outside clinical trials. Methods: We retrospectively analyzed 54 patients who received neoadjuvant chemoimmunotherapy and underwent surgical resection from 2018 to 2024. Demographics, pre-operative systemic treatment, surgical approach and postoperative outcomes were evaluated. Results: The median age was 65 years, 46% were female, and 67% of patients had a non-squamous histology, chiefly adenocarcinoma. The most common clinical stage was IIIA (54%). Major findings include a 41% pathologic complete response (pCR) and 52% major pathologic response (MPR) rate. Neoadjuvant chemoimmunotherapy resulted in downstaging in 78% (n = 42) of patients. Most patients (83%) had their operation completed robotically. R0 resection was achieved in 96%. Median length of stay was significantly shorter after robotic operations, with no significant difference in complications compared to the open group. At a median follow up of 16 months, 24 months of recurrence-free survival was estimated at 76% (95% CI: 61–94) and overall survival, 93% (CI: 84–100). Conclusion: At our medical center, induction chemoimmunotherapy followed by anatomic lung resection has resulted in a high rate of complete pathologic response, overall survival and recurrence-free survival. The robotic approach after induction chemoimmunotherapy is safe and associated with shorter length of stay and faster recovery time.