In a retrospective cohort study reported in JAMA Network Open, Desai et al examined survival outcomes with the addition of immunotherapy to neoadjuvant or adjuvant chemotherapy in patients with resectable non–small cell lung cancer (NSCLC).
Study Details
The study involved data from the Flatiron Health database on 1,334 patients diagnosed with stage II to IIIA NSCLC between January 2020 and October 2023 who underwent surgical resection. A total of 424 received neoadjuvant chemoimmunotherapy with nivolumab or pembrolizumab plus a platinum doublet, and a total of 910 received adjuvant therapy (no neoadjuvant therapy permitted) with a platinum doublet followed by atezolizumab, pembrolizumab, or immunotherapy alone with atezolizumab or pembrolizumab. All immunotherapy agents had to be approved by the FDA at time of use.
Key Findings
Clinical distant metastasis–free survival at 18 months was 80.2% (95% confidence interval [CI] = 75.0%–85.7%) in the neoadjuvant cohort and 83.0% (95% CI = 80.0%–86.0%) in the adjuvant cohort. In analysis by stage, 18-month distant metastasis–free survival was 81.5% (95% CI = 73.9%–89.9%) for stage II and 78.9% (95% CI = 72.0%–86.6%) for stage IIIA in the neoadjuvant setting and 87.3% (95% CI = 83.9%–90.9%) for stage II and 77.4% (95% CI = 72.4%–82.7%) for stage IIIA in the adjuvant setting.
A total of 66.0% of patients had PD-L1 testing. Among patients with available PD-L1 expression data, 69.1% (n = 154) in the neoadjuvant cohort and 84.2% (n = 553) in the adjuvant cohort had a PD-L1 threshold of > 1%. No differences in distant metastasis–free survival were observed according to PD-L1 expression in either cohort.
Among 132 patients with distant metastases, the most common sites were brain (n = 46, 34.8%), bone (n = 37, 28.0%), and pleura (n = 19, 14.4%). Patterns of metastases did not differ between cohorts.
Between 2022 and 2023, use of chemoimmunotherapy among patients receiving surgery increased from 8.4% to 13.8% in the neoadjuvant setting and from 19.7% to 22.6% in the adjuvant setting.
The investigators concluded: “This retrospective cohort study found that chemoimmunotherapy was associated with favorable clinical [distant metastasis-free survival] outcomes in patients with resectable NSCLC. The findings highlight the need to address barriers to broader adoption of chemoimmunotherapy.”
Aakash Desai, MD, MPH, of the Division of Hematology and Oncology, University of Alabama at Birmingham, is the corresponding author for the JAMA Network Open article.
Disclosure: For full disclosures of all study authors, visit JAMA Network Open.
