Real-world relationship of early endpoints to survival endpoints in patients with resectable non-small-cell lung cancer

Aim: Pathologic response has been shown to be a promising surrogate for survival in non-small-cell lung cancer (NSCLC). We examined the real-world relationship between these end points in patients with resectable stage IB-IIIA NSCLC receiving neoadjuvant chemotherapy/chemoradiotherapy (CT/CRT). Methods: Electronic health records/medical charts were analyzed. Overall and event-free survival (OS/EFS) were assessed by Kaplan-Meier stratified by pathologic response. Associations between the end points were assessed by Cox analyses. Results: A total of 425 patients were selected for the study; 147 and 278 received CT and CRT, respectively. Pathologic complete response (pCR) was associated with longer OS (adjusted HR = 0.50; 95% CI: 0.29-0.85) and EFS (adjusted HR = 0.44; 95% CI: 0.28-0.68) versus no pCR, and EFS was associated with OS (HR = 0.51, 95% CI: 0.38, 0.69). Conclusion: In patients receiving neoadjuvant CT/CRT, pCR and EFS were associated with improved survival in this real-world dataset. Many patients with early-stage lung cancer have their cancer come back in 2-5 years after treatment, and when it returns it is often incurable. This has been true for many cancer drugs over many years. However, developing new and better cancer drugs is difficult. In drug trials, it takes years to see if the patients live longer. Disappearance of cancer tissue can show earlier if a cancer drug is working. This is called 'pathological response'.We studied a large number of patients with early lung cancer. These patients were treated at community cancer practices. Some of these patients had pathological response. Those patients lived longer and/or it took longer for the cancer to come back. The study showed that pathological response is a faster way to see if new cancer drugs work. In patients with resectable stage IB-IIIA non-small-cell lung cancer receiving neoadjuvant chemotherapy/chemoradiotherapy at community oncology practices, complete pathologic response and event-free survival were both associated with improved survival.