What’s the optimal duration of neoadjuvant chemoimmunotherapy for resectable non-small cell lung cancer: a real-world study

Abstract 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 two 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 for 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 difference was observed in pCR rates, surgery difficulty, and postoperative complications between groups. Multivariate binary logistic regression analysis indicated that adenocarcinoma (odds ratio [OR] 0.14, 95% confidence interval [CI] 0.04–0.50, P = 0.003) and clinical T3 stage (OR 0.18, 95% CI 0.05–0.72, P = 0.015) were unfavourable factors for pCR. Kaplan–Meier survival analysis revealed no significant difference in recurrence-free survival (RFS) or overall survival (OS) between groups. Multivariate Cox regression analysis revealed that number of neoadjuvant cycles was not a predictor of recurrence (HR 0.87, 95% CI 0.31–2.44, P = 0.8). CONCLUSIONS Compared with 3 or more cycles, two 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.