Real-world experience with neoadjuvant chemoimmunotherapy in resectable NSCLC: A single academic institution experience.

Abstract

e20074 Background: Neoadjuvant chemoimmunotherapy has led to significant improvements in outcomes for patients with resectable non-small cell lung cancer (NSCLC), resulting in higher rates of pathological response and improved survival, especially in stage IIIRegarding this, we designed our real-world analysis to investigate outcomes in sigle institution center. Methods: We conducted a single-center, retrospective, real-world analysis of patients with resectable NSCLC who received neoadjuvant chemoimmunotherapy, focusing on pathological response and nodal downstaging. Results: From March 2023 to December 2025, 59 patients with resectable NSCLC completed two to four cycles of neoadjuvant chemoimmunotherapy before surgical evaluation. The median age was 66 years (range, 59-70), and 54% were male. The objective response rate was 97% per RECIST 1.1. Most patients were stage III (IIIA, 53%; IIIB, 24%). Adenocarcinoma was present in 64% (38/59), and squamous cell carcinoma in 29% (17/59). The median time to surgery was 9 weeks (range, 7-12). Pathological assessment of the primary tumor showed complete pathological response in 43% and major pathological response in another 18%. Notably, 15 patients (30%) showed a complete pathological response in both the primary tumor and lymph nodes. Among those with baseline lymph node involvement, 58% experienced nodal downstaging after neoadjuvant chemoimmunotherapy, with 50% achieving complete nodal clearance (ypN0). Additionally, 38% of cN2 patients were downstaged to ypN0. Grade 3 toxicities occurred in 7% of patients (4/59). Conclusions: Pathological response and nodal downstaging are being established as clinically meaningful surrogates for long-term outcomes in patients with resectable NSCLC treated with neoadjuvant chemoimmunotherapy. In our real-world cohort, this approach resulted in high rates of both pathological response and nodal downstaging. Further follow – up is needed to investigate tese finding on event-free survival and overall survival.