Chemoimmunotherapy for Patients with Resectable Non-Small Cell Lung Carcinoma: Real-World Data Analysis from a Surgical Point of View

Background: Neoadjuvant treatment with Chemoimmunotherapy (CIT) for patients with Non-Small Cell Lung Carcinoma (NSCLC) is a rapidly growing area of interest. Currently, several ongoing trials with varying designs are in progress, and the first immune checkpoint inhibitors are approved by the European Medicines Agency. Moreover, surgeons are facing new challenges associated with this innovative approach. Methods: We retrospectively reviewed the medical records of 18 patients who underwent neoadjuvant CIT before surgery for NSCLC between September 2019 and June 2024 at our institution. We ensured a minimum follow-up of 90 days. Results: Neoadjuvant CIT and oncological resection of NSCLC were administered to eight women and ten men. The median age was 65 years (range: 52-80 years). A total of 56% (n=10) of the patients had adenocarcinoma, and 44% had squamous cell carcinoma. A total of 56% of the patients presented with UICC stage IIIA disease (n=10), while 33% had stage >IIIA disease (n=6). The mean initial tumor size was 55 mm. Nivolumab (plus platin-based chemotherapy) was administered to 61% of the patients (n=11), 28% received pembrolizumab, 6% received cemiplimab, and 6% received atezolizumab. Restaging of the chest via computed tomography revealed stable disease in 56% of the patients, a partial response in 33%, and progressive disease in 11%. The mean surgical delay was 117 days. In 67% of the patients, the surgical approach was thoracotomy (n=12), while 33% underwent VATS (n=6). Five patients (28%) were converted; thus, the conversion ratio of the minimal approach was 45%. Sixteen patients (89%) had tumor-free margins (R0). The median hospital stay was 9 days (range: 7-77). Pathologists confirmed downstaging in 61% (n=11) of the patients. A complete pathological response was achieved in 33%, a major pathological response in 22%, and a pathological response in 33%. Based on the Clavien‒Dindo classification, 28% of the patients had no surgical complications (n=5). Grade I occurred in 28%, grade II in 33%, grade III in 6%, and grade IV in 6% of the patients. No patients died within 90 days after surgery. All patients were alive according to the latest follow-up. Conclusion: Oncologic lung resection after neoadjuvant CIT may be challenging but feasible. As visualization of the CIT response is still very limited, our data support surgical exploration after neoadjuvant CIT.