A large real-world analysis has found that perioperative chemoimmunotherapy is associated with favourable clinical outcomes in patients with resectable stage II to IIIA non–small cell lung cancer (NSCLC).
However, the study also reveals that uptake of these therapies remains low, underscoring the need to address barriers to broader adoption.
Published in JAMA Network Open, the retrospective cohort study analysed data from 1334 patients treated at more than 280 US cancer centres using the Flatiron Health database. Patients received either neoadjuvant or adjuvant chemoimmunotherapy following FDA approvals of immunotherapy in the perioperative setting.
Among 424 patients treated with neoadjuvant chemoimmunotherapy, the 18-month clinical distant metastasis–free survival (DMFS) was 80.2% (95% CI, 75.0%–85.7%). In the adjuvant group (n = 910), the 18-month DMFS was 83.0% (95% CI, 80.0%–86.0%). These outcomes suggest durable disease control with perioperative immunotherapy combinations, including PD-1 or PD-L1 inhibitors administered with or without chemotherapy.
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Despite these favourable results, adoption rates remain modest. Use of neoadjuvant chemoimmunotherapy increased from 8.4% in 2022 to 13.8% in 2023, while adjuvant use rose from 19.7% to 22.6% over the same period. Biomarker testing was more common in the adjuvant setting (PD-L1 testing: 72.2% vs 52.6% in the neoadjuvant group, P < .001), highlighting variability in treatment planning and molecular work-up.
Patterns of distant metastasis were similar between groups, with the brain, bone, and pleura identified as the most common sites of recurrence.
“The findings suggest that chemoimmunotherapy is associated with favourable clinical outcomes in resectable NSCLC; therefore, there is a critical need to address barriers to broader adoption of chemoimmunotherapy,” the authors concluded.
Barriers to uptake may include logistical delays, inconsistent biomarker testing, and institutional hesitancy to deviate from established perioperative pathways. The authors recommend targeted efforts to optimise perioperative workflows, improve biomarker access, and strengthen guideline implementation across oncology networks.
Paper: Desai A, Schwed K, Kalesinskas L, et al. Clinical Outcomes of Perioperative Immunotherapy in Resectable Non–Small Cell Lung Cancer. JAMA Netw Open. 2025;8(6):e2517953. doi:10.1001/jamanetworkopen.2025.17953
