From trial to practice: real-world outcomes of neoadjuvant chemoimmunotherapy versus chemotherapy ± radiotherapy in resectable locally advanced NSCLC.

[BACKGROUND AND OBJECTIVES] Neoadjuvant chemotherapy combined with immune checkpoint inhibitors (ChT-ICI) has shown promising efficacy in resectable locally advanced non-small cell lung cancer (NSCLC), but real-world data comparing it with conventional chemotherapy or chemoradiotherapy (ChT/ChT-RT) are limited. This study evaluated perioperative safety and oncologic outcomes of both approaches in a real-world setting.

[METHODS] A single-center retrospective analysis included consecutive patients with locally advanced NSCLC who received neoadjuvant therapy and underwent pulmonary resection between January 2017 and October 2025. Patients were grouped as ChT-ICI or ChT/ChT-RT. Primary endpoints were overall and cardiopulmonary morbidity; secondary endpoints included pathological complete response (pCR), overall survival (OS), and disease-free survival (DFS).

[RESULTS] Eighty-two patients were analyzed (36 ChT-ICI, 46 ChT/ChT-RT). Overall complications occurred in 36.1% and 43.5%, and cardiopulmonary morbidity in 8.3% and 15.2%, respectively (adjusted OR 0.359;P =  .211). pCR was significantly higher with ChT-ICI (33.3% vs 8.7%; adjusted OR 4.53; P =  .021). No significant differences were observed in OS or DFS.

[CONCLUSIONS] In this real-world cohort, neoadjuvant ChT-ICI demonstrated similar perioperative safety and a significantly higher pCR rate than conventional regimens, supporting its feasibility and therapeutic potential in resectable locally advanced NSCLC.