Real-world uptake of neoadjuvant chemoimmunotherapy and surgery in patients with stage II-IIIB non-small cell lung cancer.

OBJECTIVE: To evaluate real-world uptake, feasibility, and outcomes of neoadjuvant chemoimmunotherapy and surgery among patients with stage II-IIIB non-small cell lung cancer (NSCLC). METHODS: This retrospective cohort study included all patients diagnosed with stage II-IIIB (AJCC 8th edition, excluding N3) NSCLC between August 2022 and August 2024 at the Cancer Centre of Southeastern Ontario (CCSEO). Data on patient characteristics, treatment uptake, surgical outcomes, pathological response, and survival were collected from electronic health records. RESULTS: Of 587 patients diagnosed with NSCLC during the study period, 132 (22.5%) had stage II-IIIB disease and were included. Thirty-four patients (25.8%) underwent surgical resection, including 10 (29.4%) with upfront surgery and 24 (70.6%) following neoadjuvant chemoimmunotherapy. Overall, 26 patients (19.7%) initiated neoadjuvant chemoimmunotherapy 24/26 (92.3%) completed the planned regimen and proceeded to surgery. Among those undergoing surgery after neoadjuvant chemoimmunotherapy, pathological complete response and major pathological response were observed in 25% and 58.3% of patients, respectively. In exploratory analyses, neoadjuvant chemoimmunotherapy followed by surgery was associated with improved overall survival compared with not receiving this approach (log-rank p=0.009). CONCLUSION: In this real-world cohort, fewer than one in five patients with stage II-IIIB NSCLC received neoadjuvant chemoimmunotherapy, highlighting persistent barriers and need for alternative strategies. For those who did receive neoadjuvant chemoimmunotherapy, rates of treatment completion and surgery were higher than those reported in clinical trials..