Real-world data on the management of potentially resectable stage IB-IIIA non-small cell lung cancer (NSCLC) in the United Kingdom (UK) in 2023: Early adoption of immune checkpoint inhibitors (ICIs).

Abstract

e20618 Background: Although early-stage resectable stage IB-IIIA NSCLC has a better prognosis, it is associated with high recurrence rates within the first 5 years, even with chemotherapy (CT) administered pre- or post-surgery. Immunotherapy has revolutionized the treatment of metastatic NSCLC in the last 10 years, improving survival and providing patients with a better quality of life. Recently, ICIs have been used alone or in combination with CT for NSCLC in adjuvant, neoadjuvant, or perioperative settings, with promising results. Methods: This UK study from Q1 to Q3 2023 included 299 patients who underwent surgery for stage IB to IIIA NSCLC. Anonymous patient charts from oncologists or thoracic surgeons in the UK were analyzed. The analysis included comprehensive clinical and biological data collection with a special focus on adjuvant, neoadjuvant and perioperative treatment regimens. Results: From the 299 patients, 60% were male and 40% were female with a median age of 65 years. Ninety-percent of the patients were ECOG 0-1. Programmed Death Ligand 1 (PDL1) and Epidermal Growth Factor Receptor (EGFR) status were obtained in 206 and 218 patients, respectively. In 75% of the cases these tests were performed before surgery. At time of diagnosis 14% of the patients had Stage IB disease, 51% Stage II and 35% Stage IIIA. Seventy patients (23%) received neoadjuvant therapy: ICI±CT - 31 patients; CT only - 17 patients; Radiotherapy (RT) only – 10 patients; Concomitant Radio-chemotherapy (CRT) - 11 patients and Sequential CRT - 1 patient. The median number of neoadjuvant CT cycles was 3.7 and included in all patients a platinum-based regimen with Pemetrexed, Vinorelbine or Paclitaxel in 35%, 33% and 20% of the situations respectively. Among the ICIs, 23 patients (74%) received Nivolumab, 5 (16%) received Pembrolizumab, 2 (6%) received Atezolizumab and 1 (3%) received Durvalumab. Complete resection was obtained in 85% of the patients and the post-operative staging was: stage IA – 10% of the cases, stage IB – 20%, stage II - 38% and stage III 31%, respectively. A total of 231 patients (77%) received adjuvant therapy: CT only - 100 patients; ICI±CT - 44 patients; Concomitant CRT - 28 patients; Sequential CRT – 18 patients; RT only – 14 patients and EGFR-inhibitors 27 patients. The median number of adjuvant CT cycles was 4.3 and included in 91% of the cases a platinum-based regimen with Vinorelbine, Paclitaxel or Pemetrexed, in 48%, 19% and 13% of the situations respectively. Among the ICIs, 28 patients (64%) received Atezolizumab, 8 (18%) received Durvalumab, 6 (14%) received Pembrolizumab and 1 (4%) received Nivolumab. Conclusions: This real-life cohort highlights an early adoption of ICIs in managing patients with limited stage resectable NSCLC in the UK, with no major difficulties reported by clinicians.