2544 - Efficacy Analysis of Different Adjuvant Therapy Regimens in the Perioperative Period for Resectable Non-Small Cell Lung Cancer with Negative Driver Genes
Presenter(s)
J. Zhao1, K. Wang2, B. Huang1, M. Li1, X. Wang2, J. Zhu1, G. Cai1, and X. Meng1,3; 1Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China, 2School of Clinical Medicine, Shandong Second Medical University, Weifang, China, 3School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
Purpose/Objective(s): To investigate the effects of different adjuvant therapy regimens following neoadjuvant chemoimmunotherapy (NCIT) or adjuvant immunotherapy (AIT) after upfront surgery (US) in patients with driver gene-negative resectable non-small cell lung cancer (NSCLC).
Materials/Methods: This retrospective study included 285 patients with resectable NSCLC who received NCIT and 32 patients who received AIT after US in Shandong Cancer Hospital from 2019 to 2024. Patients were divided into untreatment (n=46), chemotherapy (n=38), immunotherapy alone (n=33), chemoimmunotherapy (n=168), and US+AIT groups according to the adjuvant therapy regimens. The primary follow-up endpoints were event-free survival (EFS) and overall survival (OS). Subgroup analyses include clinical stage, pathological responses, and PD-L1 expression level. Propensity score matching (PSM) was utilized to balance the baseline differences. EFS and OS were evaluated using the Kaplan-Meier method, and the log-rank test was used for group differences.
Results: The median follow-up time was 30.7 months. After 1:1 PSM between the immunotherapy alone and the chemoimmunotherapy group, 33 patients were matched in each group. Both before and after PSM, the immunotherapy alone and chemoimmunotherapy groups demonstrated significantly better EFS compared to the untreatment group, and there is no significant difference in either EFS or OS between the immunotherapy alone and chemoimmunotherapy groups. After PSM, both chemoimmunotherapy and immunotherapy alone significantly prolonged EFS compared to untreatment for patients who did not achieve pCR or those with PD-L1 expression =1%. However, for patients who achieved pCR, chemoimmunotherapy and immunotherapy alone showed no significant difference in either EFS or OS compared to untreatment. Additionally, among patients with PD-L1 expression =1%, immunotherapy alone and chemoimmunotherapy significantly improved EFS compared to US+AIT. Regardless of stage IB-IIB or stage IIIA-IIIB, immunotherapy alone and chemoimmunotherapy can significantly prolong EFS compared with untreatment.
Conclusion: For patients with resectable NSCLC receiving NCIT, compared with untreatment, adjuvant immunotherapy alone or chemoimmunotherapy can significantly improve prognosis, particularly for those who did not achieve pCR and have high PD-L1 expression. Future large-scale randomized controlled trials are necessary to confirm these findings.