Neoadjuvant immunochemotherapy vs. neoadjuvant targeted therapy plus chemotherapy for EGFR-mutated non-small cell lung cancer: a retrospective study

BACKGROUND: Adjuvant targeted therapy represents the standard of care for patients with resectable epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC). Neoadjuvant therapy can improve surgical and survival outcomes. This study aimed to compare the effectiveness of neoadjuvant immunochemotherapy (NICT) and neoadjuvant targeted therapy plus chemotherapy (NTCT) for EGFR-mutated NSCLCs. METHODS: In this multi-center retrospective study, we reviewed patients with EGFR-mutated NSCLC who underwent surgery following NICT or NTCT. The primary end point was major pathologic response (MPR), and the secondary end points included pathologic complete response (pCR) and 1-year disease-free survival (DFS). RESULTS: This study included 89 patients (53 females, 36 males) with a median age of 57 (Interquartile range [IQR], 51–57) years. Of these, there were 44 and 45 patients undergoing surgery following NICT and NTCT respectively. Patients who received NICT had a more advanced clinical T stage (p = 0.018), a higher frequency of harboring EGFR exon 20 insertion (P = 0.035) and a shorter length of hospital stay (p = 0.005), compared with those who received NTCT. The MPR rate was 29.5% (95% confidence interval [CI], 16.8–45.2) in the NICT group, compared with 15.6% (95%CI, 6.5–29.5) in the NTCT group (p = 0.185). The 1-year DFS rates were 0.872 (95%CI, 0.762–0.998) in the NICT group and 0.721 (95%CI, 0.586–0.887) in the NTCT group (p = 0.18). CONCLUSIONS: NICT seemed to be an effective treatment for patients with EGFR-mutated NSCLC, further randomized controlled trials are in need to validate the safety and efficacy of NICT in this setting.