What is the optimal duration of neoadjuvant chemoimmunotherapy for resectable non-small cell lung cancer (NSCLC)?: a real-world study

OBJECTIVES: The optimal duration of neoadjuvant chemoimmunotherapy for resectable non-small cell lung cancer remains unknown. This study aimed to assess whether the number of cycles of neoadjuvant therapy affects oncologic efficacy and surgical safety in a real-world setting. METHODS: Patients with resectable non-small cell lung cancer who received neoadjuvant chemoimmunotherapy and subsequent surgery were included. Patients were divided into 2 groups: ≤2 or >2 cycles. Oncology outcomes such as pathological complete response (pCR) and surgical outcomes were compared. Binary logistic regression analyses were conducted to identify independent factors for pCR. Kaplan-Meier analysis was used to compare long-term survival between groups. Cox regression analyses were conducted to identify independent predictors of recurrence. RESULTS: A total of 140 patients with clinical stage IB-IIIB disease were included; 68 received ≤2 cycles and 72 received >2 cycles of neoadjuvant chemoimmunotherapy. No significant differences between groups were observed in pCR rates, surgery difficulty, and postoperative complications. Multivariate binary logistic regression analysis indicated that adenocarcinoma [odds ratio 0.14, 95% confidence interval 0.04-0.50, P = .003] and clinical T3 stage (odds ratio 0.18, 95% confidence interval 0.05-0.72, P = .015) were unfavourable factors for pCR. Kaplan-Meier survival analysis revealed no significant difference in recurrence-free survival or overall survival between groups. Multivariate Cox regression analysis revealed that the number of neoadjuvant cycles was not a predictor of recurrence (hazard ratio 0.87, 95% confidence interval 0.31-2.44, P = .8). CONCLUSIONS: Compared with 3 or more cycles, 2 cycles of neoadjuvant chemoimmunotherapy might achieve similar perioperative outcomes and long-term survival in selected patients. Prospective studies and extended follow-up are needed to verify the conclusions.