Stage II Non-Small Cell Lung Cancer: Upfront Surgery or Neoadjuvant Chemoimmunotherapy.
Riccardo Tajè, Filippo Tommaso Gallina, Jonathan David Spicer
✦ AI-curated · Sources linked
In 30 seconds
This individual patient data meta-analysis compared neoadjuvant chemoimmunotherapy with upfront surgery in stage II non-small cell lung cancer, and also compared chemoimmunotherapy with neoadjuvant chemotherapy. Survival data included 275 patients treated with chemoimmunotherapy and separate upfront-surgery cohorts from eighth- and ninth-edition pathologic TNM databases. Chemoimmunotherapy was associated with better overall survival than the eighth-edition surgery cohort (HR, 0.68; 95% CI, 0.53-0.87; P = .002), but not the ninth-edition cohort (HR, 0.82; 95% CI, 0.64-1.1; P = .10). Compared with chemotherapy, it improved survival and pathologic response without worse reported surgical outcomes.
Key findings
- Overall survival favored chemoimmunotherapy over upfront surgery in the eighth-edition database (HR, 0.68; 95% CI, 0.53-0.87; P = .002), but not the ninth-edition database.
- Compared with chemotherapy, chemoimmunotherapy improved event-free survival (HR, 0.66; 95% CI, 0.52-0.82; P 0.001) and overall survival (HR, 0.68; 95% CI, 0.50-0.92; P = .01).
- Pathologic complete response (RR, 6.19; 95% CI, 3.37-10.27; P < .001) and major pathologic response (RR, 3.08; 95% CI, 2.27-4.16; P < .001) favored chemoimmunotherapy over chemotherapy.
- Reported surgical outcomes, including canceled surgery, pneumonectomy, conversion to open surgery, and positive margins, were similar.
Why it matters
The findings suggest that adding immunotherapy to neoadjuvant chemotherapy may improve survival and pathologic response in stage II disease, while preserving comparable reported surgical outcomes. However, the differing survival comparisons with the two TNM database cohorts underscore that estimates depend on the comparator and staging context. The results support continued attention to identifying patients at higher risk who may be most likely to benefit.
What to keep in mind
The upfront-surgery comparisons used external pathologic TNM databases rather than randomized concurrent controls, and the survival result differed between the eighth- and ninth-edition cohorts. The chemoimmunotherapy survival data included 275 stage II patients.