Surgical results after neoadjuvant nivolumab and platinum-based chemotherapy for resectable lung cancer. A multicentre European real clinical practice analysis

Abstract OBJECTIVES To evaluate the real clinical practice surgical outcomes following neoadjuvant nivolumab in combination with chemotherapy in a multicentre European cohort of patients. METHODS Retrospective analysis on consecutive patients treated in six tertiary referral hospitals in Europe with neoadjuvant chemotherapy and immunotherapy (nivolumab) for stage II-IIIB non-small cell lung cancer (March 2023-December 2024). Surgical and pathological outcomes were assessed. RESULTS 340 patients started neoadjuvant treatment. 317 patients (93.2%) were able to proceed to surgery. 47% of patients had surgery more than 6 weeks after completion of the last neoadjuvant cycle. 208 operations (66%) were started using a minimally invasive approach with a conversion rate of 18%. The most frequent resection was lobectomy in 86% of patients. 90-days postoperative mortality rate was 2.5%. The pathologic complete response occurred in 95 patients (30% of the surgical patients), major pathologic response in 167 patients (52.7% of the surgical patients). The incidence of pathologic complete response (p = 0.78) and major pathologic response (p = 0.26) were similar in patients with clinical stage II and III. Pathologic complete response rate was higher in patients with PD-L1 ≥ 50% compared to those with PD-L1 50% (37.5% vs 27.2%, p = 0.082). A higher pathologic complete response (39% vs 23%, p = 0.004) and major pathologic response (66% vs 45%, p = 0.001) was observed in squamous vs non-squamous histology tumours. CONCLUSIONS The use of neoadjuvant nivolumab in association with platinum-based chemotherapy in the real clinical practice is safe and effective. Our real clinical practice data represent valuable information to be used during multidisciplinary treatment selection for clinical stage II and III resectable non-small cell lung cancer and shared decision-making.