Neoadjuvant Chemoimmunotherapy in Resectable IIIA/IIIB Non-small Cell Lung Cancer

Abstract Background: A small portion of patients experience objective clinical benefit after neoadjuvant PD-1 blockade in NSCLC. The combining checkpoint blockade and chemotherapy as neoadjuvant chemoimmunotherapy therapeutic regimen might be more effective but has not been tested in resectable stage IIIA/IIIB NSCLC. Methods: This is a retrospective study of 35 patients with resectable stage IIIA and IIIB NSCLC who were treated with neoadjuvant chemoimmunotherapy (NCIO). The pathological complete response (pCR), major pathologic response(MPR), the safety and feasibility were evaluated. The correlation between the pathology response and some clinical factors was studied to identify some predictors. Results: NCIO was associated with few immediate adverse events. The NCIO did not delay planned surgery and led to a complete pathological response(pCR) in 51.43% patients and a major pathological response in 74.29% patients in the primary tumor. No association was observed between PD-L1 expression before the treatment and pathological response to the NCIO (Pearson’s r=-0.071; P=0.685). However, significant difference was observed between invasion status of the bronchus(ISB) and pathological response (P<0.05). The patients with Invade status were with higher pCR and MPR rates as compared with No-Invade status, with 76.47% pCR and 100% MPR rate vs. 31.58% pCR and 50.00% MPR rate(Pearson’s r=0.7280; P=0.0009).Conclusions: NCIO was associated with few side effects, did not delay surgery, and induced a complete pathological response in 51.43%% of resected tumors. No significant correlation between the pathological response and PD-L1 expression. While the ISB was predictive of the pathological response to NCIO.