Immunotherapy Compliance in Non-Small Cell Lung Cancer: Study Reveals Challenges and Opportunities

Strategic Insights -

According to a recent systematic review and meta-analysis, compliance with immunotherapy protocols in non-small-cell lung cancer (NSCLC) remains a significant challenge, particularly in adjuvant and perioperative settings. The study, conducted by a team of researchers from the Department of Cardio-Thoracic and Vascular Surgery at Azienda Ospedaliera-Universitaria Citta della Salute e della Scienza di Torino in Turin, Italy, aimed to evaluate compliance rates with immunotherapy-based protocols in neoadjuvant, adjuvant, and perioperative settings for resectable NSCLC.

Key Takeaways:

  • The study included 30 prospective clinical trials involving over 10,493 patients, with 26 studies investigating immunotherapy alone or in combination with chemotherapy in neoadjuvant settings.
  • In neoadjuvant settings, nearly all patients received at least one therapy administration, while 11.3% experienced incomplete cycles, and 16.1% of cases did not undergo surgery.
  • The overall protocol compliance was superior in neoadjuvant protocols (effect size: 0.78 [IC 95%: 0.70-0.85]) compared to adjuvant protocols (effect size: 0.61 [IC 95%: 0.53-0.69]) and perioperative protocols (effect size: 0.49 [IC 95%: 0.43-0.55]).
  • However, perioperative protocols showed similar compliance and Grade 3 AE rates compared to preoperative and postoperative protocols.
  • Improving protocol compliance through tailored strategies and multidisciplinary coordination is essential to maximize the therapeutic potential of immunotherapy in resectable NSCLC and enhance patient outcomes.

Statistics:

  • The study included 30 prospective clinical trials involving over 10,493 patients.
  • In neoadjuvant settings, 26 studies investigated immunotherapy alone or in combination with chemotherapy.
  • 11.3% of patients experienced incomplete cycles of immunotherapy.
  • 16.1% of cases did not undergo surgery.
  • The overall protocol compliance rate was 80.5% in neoadjuvant settings.
  • The effect size for protocol compliance in neoadjuvant settings was 0.78 (IC 95%: 0.70-0.85).
  • 67.7% of patients experienced Grade 3 adverse events (AEs) in neoadjuvant settings.
  • 19.0% of patients experienced Grade 3 AEs in adjuvant settings.

Sources:

  • Attrition with adjuvant, neoadjuvant, and perioperative immunotherapy-based treatment protocols in patients with resectable non-small-cell lung cancer. A meta-analysis of prospective trials. Lung Cancer, 2025;209:108760.
  • Department of Cardio-Thoracic and Vascular Surgery, Azienda Ospedaliera-Universitaria Citta della Salute e della Scienza di Torino, Turin, Italy.
  • Francesco Guerrera, Filippo Tommaso Gallina, Eleonora Balzani, Francesca Ambrosi, Alessandro Di Federico, Eleonora Faccioli, Giorgio Facheris, Roberto Ferrara, Alessandra Ferro, Federica Filipello, Raffaele Giusti, Carlo Greco, Marco Mammana, Daniele Mar.