WCLC 2025 - Posters & ePosters-P1.07.31 Adjuvant Immunotherapy for Clinically Node-Negative Non-Small Cell Lung Cancer

Pdf Summary

This study analyzed real-world outcomes of adjuvant immunotherapy combined with chemotherapy versus chemotherapy alone in patients with clinically node-negative non-small cell lung cancer (NSCLC) who experienced nodal upstaging post-surgery. Using data from the National Cancer Database (2017–2021), the cohort included 6,913 patients with cT1-2, cN0, cM0 lung adenocarcinoma or squamous cell carcinoma who underwent upfront resection without neoadjuvant therapy. Nodal upstaging was identified in 11.9% of cases.<br /><br />The majority were clinical stage I (90%) and underwent lobectomy (83.3%). Patients received either adjuvant chemotherapy (68.7%), chemoimmunotherapy (5.5%), or observation (19.8%). Three-year overall survival (OS) rates were 76.8% for chemotherapy, 67.8% for chemoimmunotherapy, and 62.5% for observation. After adjusting for patient and tumor variables with propensity matching and Cox proportional hazards modeling, no survival advantage was found for adjuvant chemoimmunotherapy compared to chemotherapy alone.<br /><br />The findings suggest that non-targeted use of adjuvant chemoimmunotherapy in resected NSCLC with nodal upstaging may not yield significant survival benefits over standard chemotherapy. The study highlights the need for further research to better select patients who might derive benefit from immunotherapy in the adjuvant setting. This could optimize personalized treatment approaches for NSCLC patients with occult nodal disease discovered after surgery. In conclusion, while surgery remains primary treatment, adjuvant therapy choice should be carefully considered, and indiscriminate addition of immunotherapy to chemotherapy does not consistently improve outcomes in this population.

Asset Subtitle

Giorgio Caturegli

Meta Tag

Speaker Giorgio Caturegli

Topic Early-Stage Non-small Cell Lung Cancer

Keywords

adjuvant immunotherapy

chemotherapy

non-small cell lung cancer

NSCLC

nodal upstaging

real-world outcomes

National Cancer Database

overall survival

propensity matching

chemoimmunotherapy