92P Predictors, surrogate and patient-reported outcomes in neoadjuvant immunotherapy for lung cancer: A single-center retrospective study

Development of immunotherapy/molecular targeted therapy has significantly increased survival/QoL in advanced stages of NSCLC. Aim: to analyze outcome predictors, surrogate outcomes, and PROMs after neoadjuvant immunotherapy for initially unresectable NSCLC. Initially unresectable NSCLC (2014–2021) patients who received immunotherapy ± platinum-based chemo and/or radiotherapy evaluated after response (reduction of primary tumor and/or mediastinal lymphadenopathy/control of distant metastatic disease underwent surgical resection). PROMs were recorded using EORTC QLQ-29. 19 underwent salvage surgery after ICI. 14 had partial response (73.6%), 5 stable disease. Diagnosis was achieved by endobronchial ultrasound (EBUS) in 8 (42.1%), fine-needle aspiration biopsy (FNAB) in 7 (36.8%), metastasis biopsy in 4 (21.0%). 11 (57.9%) were treated with neoadjuvant platinum-based chemo before or with ICI, 1 (5.2%) pemetrexed before ICI, 5 (26.3%) radiotherapy for metastatic control. 3 (15.7%) had ICI adverse effects. Radiotherapy was never used preoperatively for pulmonary/mediastinal disease. 7 (36.8%) received adjuvant therapy (5 [26.3%] pembrolizumab, 1 [5.2%] pemetrexed, 1 [5.2%] pemetrexed + pembrolizumab). 4 (21.0%) had local relapse (no systemic relapse). Median OS was 19 months (range: 2–57.4). At 2 months, 94.7% were alive (6 months: 89.5%; 31 months: 79.5%). 2 (10.5%) had local recurrence. 2 (10.5%) died due to recurrence, 1 (5.2%) to COVID. 4 (21.0%) relapsed (median DFS: 5.3 months [range: 2.2–13.0]). PROMs were reviewed retrospectively at 30 days/1 year with significant decrease in coughing, side effects of treatment, surgery-related problems. Table 92PData as No (%), median (range), mean ± SDAge M/F66 (47–76) 8.5Adenocarcinoma11 (57.9)Squamous cell5 (26.3)Other3 (15.6)Clinical StageBefore ICIAfter ICIIA4 (21.0)IIB3 (15.7)IIIA3 (15.7)2 (10.5)IIIB4 (21.0)3 (15.7)IIIC3 (15.7)IVA8 (42.1)7 (36.8)IVB1 (5.2)Pembrolizumab14 (73.6)Nivolumab3 (15.7)Atezolizumab2 (10.5)Lobectomy15 (78.9)Pneumonectomy2 (10.5)Other2 (10.5)Pathological responseComplete7 (36.8)Major3 (15.7)EORTC QLQ-2930 d1 yp-valueCoughing18.8 ± 15.55.5 ± 10.20.19Shortness of breath11.1 ±11.88.1 ± 9.80.84Side effects of treatment10.5 ±6.57.7 ± 4.40.91Fear of progression13.3 ±16.96.6 ± 13.80.40Surgery related problems10.2 ±9.44.0 ± 6.00.53 Open table in a new tab Radical surgical resections following definitive immunotherapy/immune-chemotherapy in selected initially unresectable NSCLC are feasible and safe (low surgical-related mortality and morbidity). Symptoms and surgery-related outcomes were lower with higher QoL due to a selected group of highly motivated patients.