P90 Surgical outcomes after neoadjuvant nivolumab and platinum-based chemotherapy in resectable non-small cell lung cancer

Objective

To evaluate the surgical outcomes following neoadjuvant chemo-immunotherapy and surgery for locally advanced non-small cell lung cancer.

Methods

Prospective analysis on all consecutive patients who underwent neoadjuvant chemotherapy and nivolumab followed by surgery (March 2023-April 2024), in a single centre. Indication for neoadjuvant treatment was tumour size ≥4cm or biopsy proven nodal disease. Patients met with an oncologist and surgeon prior to initiation of pathway, to ensure resectability and operability.

Results

Forty-seven patients entered the neoadjuvant pathway. PD-L1 expression was >1% in 66% of patients. Adenocarcinoma was the histological subtype in 64% of patients. Six (12.7%) patients did not proceed to surgery: 4 for disease progression, 2 for toxicity and poor fitness after chemo-immunotherapy. 38 patients (93%) completed all three planned neoadjuvant cycles. 12 patients (29%) were operated 6 weeks or more after completion of the neoadjuvant treatment. Of the 41 patients that proceeded to surgery, 36 (88%) were accessed minimally invasively (conversion rate 22%). Lobectomy was the most common resection (35 [85%]) with a single pneumonectomy (2.4%). Median length of stay was 4.5 days (IQR 3 – 7.5 days). Twenty-seven (66%) patients had a pathological downstaging. R0 resection was achieved in all but one patient (98%). Ten (24%) patients had a complete pathological response (cPR) with a further 17 (66%) having a major pathological response (MPR). In the subgroup analysis (table 1) cPR was significantly higher in the non-adenocarcinoma group while there were no differences in cPR by stage and by PD-L1 expression. Two patients died within 90 days from the operation (4.9%).

Conclusion

Our surgical findings appear like those reported by the Checkmate 816 trial (histology, PDL-1 expression, surgical rate). Importantly, we found similar rates of MPR and cPR amongst our cohort and the Checkmate 816 findings.