Is full adherence mandatory? Real-world outcomes of completing perioperative chemoimmunotherapy in resectable non-small cell lung cancer.

Background: Neoadjuvant chemoimmunotherapy and adjuvant immunotherapy is a standard of care for resectable non-small cell lung cancer. However, high non-adherence rates challenge its implementation and benefits. We assessed the risks and long-term outcomes of completing this full regimen versus non-completion in a real-world setting. Methods: Patients with resectable non-small cell lung cancer at clinical stage IB-IIIB who received neoadjuvant chemoimmunotherapy followed by surgery were included. Patients were divided into a completed group (n=37), who received four cycles of perioperative chemoimmunotherapy and one year of adjuvant immunotherapy, and a non-completed group (n=127). Inverse Probability of Treatment Weighting was used to adjust baseline characteristics. Kaplan-Meier curves compared recurrence-free survival, overall survival, and cumulative hazard of adverse events. Cox regression models assessed predictors for recurrence and subgroup analyses were performed. Results: No significant differences were in recurrence-free survival (P = 0.85) or overall survival (P = 0.34) between the two groups. Positive pathological nodal status was an independent predictor of recurrence, while completion status was not (adjusted hazard ratio 1.14, 95% CI 0.24-5.50, P = 0.87). The completed group experienced a higher incidence of any-grade adverse events (AEs), but no significant increase in Grade 3/4 AEs. Subgroup analysis revealed a notable recurrence benefit from completion in patients who were aged <65 years and ECOG score 0. Conclusion: Completing perioperative chemoimmunotherapy protocol did not significantly increase the risk of severe AEs, but also failed to demonstrate a survival benefit. Prospective studies and extended follow-up duration were needed to verify the conclusions.