Comparison of induction chemoimmunotherapy with surgery and concurrent chemoradiation followed by immunotherapy for potentially resectable stage III non-small-cell lung cancer: A retrospective study.

Abstract

e20050 Background: Despite the promising potential of neoadjuvant chemoimmunotherapy for non-small cell lung cancer (NSCLC), there is limited consensus on the optimal treatment strategy for potentially resectable NSCLC. This study aimed to evaluate the efficacy and safety of induction chemoimmunotherapy followed by surgery (CT/IO+Surgery) versus definitive concurrent chemoradiation followed by immunotherapy (cCRT+IO) in potentially resectable stage III NSCLC. Methods: Patients with potentially resectable stage III NSCLC who underwent CT/IO+Surgery or cCRT+IO between March 2020 and June 2023 were included. Propensity score matching (PSM) was used to balance heterogeneity between groups. Efficacy outcomes, safety profiles, and pattens of disease recurrence were assessed. Results: A total of 263 eligible patients were enrolled, of whom 150 (57.0%) underwent CT/IO+Surgery and 113 (43.0%) received cCRT+IO. After 1:1 PSM, each group consisted of 77 patients. The median progression-free survival (PFS) was 27.1 months in the cCRT+IO group and not reached (NR) in the CT/IO+Surgery group (hazard ratio: 0.41, 95% confidence interval: 0.23-0.73 p=0.002). Median overall survival (OS) was NR in either group, with 3-year OS rates of 84.8% in the CT/IO+Surgery group and 76.8% in the cCRT+IO group. The incidence of grade 3/4 treatment-related adverse events was similar in both groups, except for a higher incidence of grade 3/4 hematological toxicity in the cCRT+IO group (42.8% vs. 10.4%). Conclusions: For patients with potentially resectable stage III NSCLC, CT/IO+Surgery appears to be a safe approach and may offer better survival outcomes compared with cCRT+IO. Prospective randomized trials are needed to further validate these findings.