2481 - Clinical Outcomes of Neoadjuvant Chemoimmunotherapy vs. Neoadjuvant Chemoradiotherapy in the Treatment of Operable Non-Small Cell Lung Cancer
Presenter(s)
T. Sherman1,2, N. Nair3, K. Meller4, R. Anderson5, G. Jimenez6, E. Flevora7, C. Solomides8, R. Axelrod9, S. Gordon10, I. Micaily11, M. Werner-Wasik12, S. Whang13, T. Grenda5, O. Okusanya5, N. Evans14, N. Haldar1, and E. Blomain15; 1Dept of Radiation Oncology, Thomas Jefferson University Sidney Kimmel Cancer Center, Philadelphia, PA, 2Drexel University College of Medicine, Philadelphia, PA, 3Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center of Thomas Jefferson University, Philadelphia, PA, 4Philadelphia College of Osteopathic Medicine, Huntingdon Valley, PA, 5Thomas Jefferson University, Philadelphia, PA, 6Ponce Health Sciences University, Ponce, PR, 7Dept. of Pathology and Genomic Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, 8Thomas Jefferson University Hospital, Philadelphia, PA, 9Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, 10Department of Medical Oncology, Thomas Jefferson University Sidney Kimmel Cancer Center, Philadelphia, PA, 11Department of Medical Oncology -Thomas Jefferson University Hospital, Philadelphia, PA, 12Department of Radiation Oncology, Sidney Kimmel Cancer Center, Philadelphia, PA, 13Department of Surgery-Cardiothoracic - Thomas Jefferson University Hospital, Philadelphia, PA, 14Dept of Surgery, Thomas Jefferson University, Philadelphia, PA, 15Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA
Purpose/Objective(s): Recently, the landmark CheckMate 816 trial defined a role for neoadjuvant therapy, specifically chemoimmunotherapy (chemoIO), in the treatment of operable early-stage non-small cell lung cancer (NSCLC). Additionally, neoadjuvant chemoradiotherapy (chemoRT) is currently used in specific clinical circumstances in the preoperative setting. Despite these treatment paradigms, there is a paucity of data on how chemoRT compares to chemoIO regarding clinical outcomes. In that context, the present study compares clinical outcomes between patients who received neoadjuvant chemoRT versus systemic therapy.
Materials/Methods: A retrospective review of 89 patients with primary NSCLC who received neoadjuvant therapy was conducted, with 42 patients receiving neoadjuvant chemoRT (chemoRT group) and 47 receiving neoadjuvant systemic therapy (chemo group). Kaplan-Meier survival curves were used to compare PFS and OS between the two groups. Additional analyses included comparison of local failures, toxicity profiles, genetic mutations, and demographic characteristics.
Results: Patient demographics and treatment information are reported. 55% (26/47) of patients in the chemo group received chemoIO, the rest received chemotherapy. RT doses ranged between 50.4 – 60 Gy. Patients treated in the chemo group demonstrated a longer median PFS (24 months) than those who received chemoRT (17 months). Local control at 4 years was better in the ChemoRT group (95% versus 75% in the chemo group). The 5 year overall survival rates of both cohorts were similar at ~70%. Propensity-matched analysis, local failure analysis, mutational analysis, recurrence patterns, and treatment-related toxicities are also reported.
Conclusion: Neoadjuvant chemo demonstrated a more favorable PFS and worse local control than the chemoRT group. Overall survival was similar in both cohorts. Additionally, the present study presents the safety and feasibility of chemoRT in this setting. This may be of particular clinical interest in scenarios where the predicted response to chemoIO would be poor (i.e., 0% PDL1 tumors). These findings support further prospective studies to refine patient selection and optimize neoadjuvant treatment strategies.