Abstract 167P
Background
Preoperative CT-ICI showed better Event Free Survival (EFS) in treatment of resectable NSCLC. However, head-to-head comparison between continuation or not of adjuvant ICI are lacking. Herein, we indirect compare NEO and PERIOP strategies from published Randomized Clinical Trials (RCT) according to PR.
Methods
RCTs investigating NEO and PERIOP CT-ICI with CT alone in resectable NSCLC and reporting EFS Kaplan Meier (KM) curves by PR (complete, pCR; major, MPR) were identified. Graphical reconstructive algorithm was used to retrieve IPD from EFS KM. Bipartite-matching algorithm was used to derive unreported IPD of patients with 1–10% Residual Vital Tumor (pure-MPR), subtracting pCR from MPR group. Survival analyses were performed by Cox-proportional hazard model and log-rank test.
Results
IPD were collected for pCR, MPR and no-MPR patients from 1 NEO (CheckMate-816) and 4 PERIOP (CheckMate-77 T, KEYNOTE-671, NADIM- II, NeoTORCH) RCTs. EFS with NEO/PERIOP CT-ICI was significantly different according to PR achieved. Indeed, pCR group performed significantly better than pure-MPR (HR 0.37, 95% CI 0.21–0.66, p < 0.01) and no-MPR groups (HR 0.12, 95% CI 0.07–0.19, p < 0.01) and, similarly, pure-MPR group better than no-MPR (HR 0.58, 95% CI 0.48–0.70, p < 0.01). PERIOP showed no difference compared to NEO in EFS across all the PR subgroups: pCR (HR 0.70, 95% CI 0.26–1.88, p=0.48), pure-MPR (HR 0.63, 95% CI 0.26–1.41, p=0.26) and no-MPR (HR 1.14, 95% CI 0.79–1.65, p=0.47). While in pCR patients PERIOP and NEO CT-ICI survival curves overlapped, a separation of KM curves favouring PERIOP and NEO in pure-MPR and no-MPR subgroups, respectively, was observed.
Conclusions
Our analysis reinforces the prognostic value of the different PR achieved following preoperative CT-ICI. In particular, by taking into account the separation of KM curves by treatment strategy observed among the PR groups, a PR-based algorithm could prove valuable: adjuvant ICI could be unnecessary in pCR and worthless in no-MPR groups, while continuation of ICI might be beneficial particularly for patients who achieved pure-MPR.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.