Surgical Demand Impact of New Immunotherapy Neoadjuvant Approaches in Lung Cancer

Abstract

Aims
The standard of care for stage III lung cancer has been combined chemotherapy with radiotherapy without recourse to surgery. The Checkmate 816 trial has established neoadjuvant chemo-immunotherapy followed by surgery as the new standard for management of stage III disease. We explore the service demand implications of this new additional surgical cohort.

Methods
Retrospective study of non-small cell lung cancer (NSCLC) patients amongst those discussed in multi-disciplinary meetings (MDM) from January 1st to December 31st 2023. Patients were included if there was a documented diagnosis of NSCLC with a defined TNM Classification (8th Edition).

ResultsIn this 12-month period, 1034 unique patients were discussed. A new diagnosis of NSCLC was made in 252 cases. Stage I / II cases accounted for 98 (39%) of cases with 70 (27%) in the stage III group. Among the stage III group, PD-L1 was expressed in 29/70 (41%).

Discussion
Surgery has been limited to stage I & II cases. With new immunotherapy approaches, stage III cases should now be considered for surgery also. This could increase surgical demand, with very specific demands regarding timing. Not all patients will be suitable by performance status, but the service plans need to anticipate an increase in activity.