Carla Vega, MD
(She/Her/Hers)
Rank
Fellow or Postdoc
Department
Surgery
Thoracic Surgery
Authors
Rafael R. Barcelos, MD, Miles A. McAllister, BA, Evert A. Sugarbaker, BS, Rachel Leo, BA, Sangmin Kim,MD, Fatemehsadat Pezeshkian, MD, Anupama Singh, MD, Carla Vega*, MD, Scott J. Swanson, MD, Paula A. Ugalde Figueroa, MD
Principal Investigator
Paula A. Ugalde Figueroa
Twitter / Website
Categories
INTRODUCTION
Phase III trials of neoadjuvant chemoimmunotherapy utilizing immune checkpoint inhibitors followed by surgery have demonstrated favorable oncological outcomes in resectable NSCLC. We assessed the adoption of neoadjuvant chemoimmunotherapy at our center after FDA approval in March 2022.
METHODS
We identified patients who underwent NSCLC surgery with tumors ≥4 cm or nodal involvement between June 2022 and March 2024. Patients with N3 or oligometastatic disease were excluded. Demographics and preoperative workup were compared between those receiving neoadjuvant therapy (chemoimmunotherapy or chemotherapy+/-radiation) and upfront surgery.
RESULTS
Of 103 patients with stage IB-IIIB NSCLC, 67% received neoadjuvant therapy (52 chemoimmunotherapy, 17 chemotherapy+/-radiation). These group of patients were younger (66 vs. 72 years, p<0.001) and patients with cN1-2 disease receive neoadjuvant treatment more frequently than patients with lesion ≥ 4cm. Invasive mediastinal staging and mutational testing were more common in the neoadjuvant group. Multinomial regression adjusting for clinical factors showed that patients were less likely to undergo chemotherapy±radiation (OR=0.71, 95%CI 0.50-1.02) or upfront surgery (OR=0.68, 95%CI 0.48-0.96) compared to chemoimmunotherapy as the study progressed.
CONCLUSIONS
The use of neoadjuvant chemoimmunotherapy has increased, especially in patients with lymph node metastasis and large tumors. Multidisciplinary collaboration is essential to ensure guideline-based care, and further real-world data are needed to refine decision-making.
