AB062. SOH25_AB_105. Surgical demand impact of new immunotherapy neoadjuvant approaches in lung cancer

Background: The standard of care for stage three lung cancer has been combined chemotherapy with radiotherapy without recourse to surgery. However developments in immunotherapy have motivated new approaches to stage three lung cancer. The Checkmate 816 trial has established neoadjuvant chemo-immunotherapy followed by surgery as the new standard for management of stage III disease. The National Cancer Control Programme (NCCP) committed to fund this new therapy from May 2nd 2024. 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 lung multidisciplinary meeting (MDM) over a 1-year period from Jan 1st–Dec 31st 2023. Patients were included if there was a documented diagnosis of NSCLC with a defined tumor node metastasis (TNM) classification (8th edition).

Results: In this 12-month period, 1,034 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 II group, programmed death-ligand 1 (PD-L1) was expressed in 29/70 (41%). This could lead to an additional 29 cases requiring surgery, a 29% increase in surgical demand.

Conclusions: Surgery offers the best outcomes in NSCLC, but has been limited to stage I and II cases. With new immunotherapy approaches, stage III cases should now be considered for surgery also. This could increase surgical demand by 29%, with very specific demands regarding timing. Not all patients will be suitable by performance status however service plans should anticipate an increase in activity.

Keywords: Lung cancer; immunotherapy; non-small cell