Neoadjuvant PD-1 inhibitors and chemotherapy for locally advanced NSCLC: A retrospective study.

Chen, Tianxiang; Ning, Junwei; Campisi, Alessio; Dell'Amore, Andrea; Ciarrocchi, Angelo Paolo; Li, Ziming; Song, Liwei; Huang, Jia; Yang, Yunhai; Stella, Franco; Luo, Qingquan

BACKGROUND Stage III non-small cell lung cancer (NSCLC) encompasses a variety of local invasion and nodal involvement and its management is still under debate. Immune checkpoint inhibitors (ICI) have been shown to improve the survival in metastatic NSCLC, but are far from being accepted as an induction therapy. METHODS We retrospectively collected data of all patients who received induction ICI (nivolumab or pembrolizumab) and chemotherapy (carboplatin with paclitaxel) for stage IIIA-B NSCLC followed by surgery in our unit between January 2019 and March 2020. RESULTS Of the 12 patients (9 males, 3 females) 6 had a squamous cell carcinoma, 3 had adenocarcinoma, 1 had an undifferentiated adenocarcinoma and 1 had adeno-squamous carcinoma. Seven patients had stage IIIA disease and 5 had stage IIIB. After induction therapy, 6 patients had stable disease and 6 had a partial response. The median tumor reduction was 3.05 cm (range 2.30-8.70). All patients, but one due to the Coronavirus Disease 2019 outbreak, had no delay in surgery. Two patients experienced myelosuppression after induction therapy, two had minor adverse effects. Three patients had postoperative complications not related to the induction therapy. All patients had a pathological response: 5 complete, 4 major and 3 partial. Eleven patients are alive (mean months of follow-up 18.17±4.97) and free of disease. CONCLUSIONS Induction ICI-chemotherapy may be a valid treatment in patients with locally advanced NSCLC, providing important tumor downstaging and rendering patients operable. In our experience patients had few side effects and a good pathological response.