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Abstract
Introduction. This study presents the experience with induction chemoimmunotherapy (iCIT) in patients with stage III borderline resectable non-small cell lung cancer (NSCLC).
Aim. To evaluate the efficacy of iCIT in the treatment of locally advanced NSCLC.
Materials and Methods. In this prospective, non-randomized study, eligible patients were >18 years old with treatment-naïve, morphologically confirmed stage III NSCLC without activating mutations. The induction regimen consisted of four cycles of platinum-doublet chemotherapy combined with pembrolizumab, followed by either surgical resection or radiotherapy based on tumor resectability and patient performance status. The primary endpoint was progression-free survival (PFS).
Results. Between September 2021 and March 2024, 65 patients (median age 65 years; male:female ratio 55:10) were enrolled. Disease staging (TNM8) distribution was: IIIA (53.8 %, n = 35), IIIB (38.5 %, n = 25), and IIIC (7.7 %, n = 5). Histological subtypes included adenocarcinoma (32.3%, n = 21) and squamous cell carcinoma (67.7 %, n = 44). PD-L1 expression was assessed in 80 % (n = 52) of patients: <1% (46.1 %), 1-49% (15.4 %), and ≥ 50% (18.5 %). Radiographic response by chest MSCT was evaluable in 62 patients (95.4%) of 65 patients, in 3 (4.6 %) it was not assessed due to death after 1 and 2 courses of therapy, showing partial response (PR) in 49.2 % (n =3 2), complete response (CR) in 9.2 % (n = 6), and stable disease (SD) in 27.7 % (n = 18). Disease progression occurred in 9.2 % (n = 6). Following iCIT, 53.9 % (n = 35) underwent surgery and 27.7 % (n = 18) received radiotherapy. With a median follow-up of 14.4 months (range 6.3-23.4), median PFS was 16.3 months.
Conclusion. Preoperative chemoimmunotherapy demonstrates promising initial outcomes in borderline resectable, locally advanced NSCLC, though requires further investigation.
References
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