Real-World Neoadjuvant Treatment Patterns and Outcomes in Resected Non–Small-Cell Lung Cancer

Background Novel neoadjuvant chemoimmunotherapy treatments are being investigated for locally advanced non-small cell lung cancer (NSCLC), but real-world outcomes for neoadjuvant treatments are poorly understood. This study examined neoadjuvant treatment patterns, real-world event-free survival (rwEFS) and overall survival (OS) in patients with resected, stage II–III NSCLC in the United States (US). Methods This retrospective study identified patients in the SEER–Medicare database (2007–2019) with newly diagnosed stage II, IIIA, and IIIB (N2) NSCLC (AJCC 8th edition) treated with neoadjuvant chemo/chemoradiotherapy and resection (index date: neoadjuvant therapy initiation). Neoadjuvant treatment regimens were described. rwEFS (time from index to first recurrence or death, whichever occurred first) and OS (time from index to death) were summarized by Kaplan–Meier analysis for overall population, by disease stage at diagnosis, and by neoadjuvant treatment modality. Results 221 patients (stage II, N=70; stage III, N=151) met eligibility criteria. The median follow-up from index was 32.7 months. All patients received neoadjuvant chemotherapy (51%) or chemoradiotherapy (49%) prior to surgery; 97% of patients received platinum-based regimens, among which carboplatin+paclitaxel was the most frequent (45%). In all patients, median rwEFS was 17.6 months and 5-year rwEFS was 20.9%; median OS was 48.5 months and 5-year OS was 44.9%. 71% of patients had disease recurrence during follow-up; among them, 28% developed locoregional recurrence as the first recurrence event. Conclusions Patients with resected, stage II–III NSCLC who received neoadjuvant chemo/chemoradiotherapy have high rates of disease recurrence and poor survival outcomes, highlighting need for more effective treatments to improve survival rates. MICROABSTRACT This study aimed to examine treatment patterns, real-world event-free survival and overall survival among patients with resected, stage II-III NSCLC who received neoadjuvant treatment using SEER-Medicare data (2007-2019). Among 221 patients included, 71% experienced disease recurrence during follow-up; at 5 years, only 20.9% remained event-free and 44.9% stayed alive. These findings highlight the unmet need for more effective neoadjuvant treatments.