Predictors of the Immediate Effectiveness of Neoadjuvant Immunochemotherapy in Patients with Operable Forms of Non-Small Cell Lung Cancer: Real Data of N.N. Blokhin National Medical Research Center of Oncology

Perioperative platinum-based chemotherapy provides modest improvement in long-term outcomes following radical surgical treatment in patients with non-small cell lung cancer (NSCLC). Neoadjuvant chemotherapy is associated with a relatively low rate of achieving complete and major pathological response, which are positively correlated with improved long-term outcomes. In recent years, significant progress has been made with the introduction of immuno-oncological agents, particularly checkpoint inhibitors. The success of their application in the treatment of advanced stages of lung cancer, both as monotherapy and in combination with chemotherapy, has laid the foundation for exploring their efficacy in earlier stages of the disease. Purpose. To evaluate the pathological response to neoadjuvant immunochemotherapy in patients with operable non-small cell lung cancer. Material and methods. This study included 60 patients with resectable NSCLC (stages IB–IIIB TNM8) who underwent preoperative systemic therapy followed by radical surgical resection between 2019 and 2023 in the N.N. Blokhin National Medical Research Center of Oncology. The neoadjuvant treatment regimen consisted of three cycles of combination therapy: pembrolizumab (200 mg) plus platinum-based chemotherapy, administered every 21 days at the investigator’s discretion. Following neoadjuvant therapy, all patients underwent radical surgical resection with histopathological examination of the resected specimens. The study assessed the rates of major pathological response and complete pathological response and analyzed the impact of baseline clinicopathological factors on treatment outcomes. Results. The rate of complete pathological response among all patients was 41.7% (25/60), while the major pathological response was achieved in 60% (36/60) of cases. A significant advantage in MPR frequency was observed in patients with a positive smoking status (66.7%; p = 0.0049). A trend towards higher MPR rates was also noted in patients without driver mutations (62.8%; p = 0.0607). Differences in the frequency of pathological responses based on disease stage and PD-L1 expression levels did not reach statistical significance. Conclusion. Neoadjuvant immunochemotherapy demonstrates high pathological response outcomes, supporting its consideration as a new standard of care for resectable NSCLC, particularly for patients with a positive smoking status and without driver mutations. The identified trends warrant further investigation, including an analysis of long-term outcomes.