Optimizing Early-Stage NSCLC Management Through Multidisciplinary Strategies: ASCO 2025 - Episode 5
ASCO 2025 Real-World Data on Neoadjuvant Therapy in Stage II to III NSCLC: Surgical Outcomes and Clinical Implications
Panelists discuss how real-world data from the Flatiron Health database revealed that surgical completion rates after neoadjuvant therapy are lower in community practice (65%) compared with clinical trials, particularly for patients with poor performance status or more advanced stage disease.
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Real-world evidence from the Flatiron Health database, presented at the 2025 American Society of Clinical Oncology Annual Meeting, reveals important disparities between clinical trial outcomes and community practice patterns in neoadjuvant chemoimmunotherapy delivery. The analysis of approximately 500 patients across the United States showed overall surgical completion rates of 65%, lower than the 75% to 80% rates typically observed in clinical trials. This difference highlights the challenges of implementing complex treatment protocols in diverse health care settings without the structural advantages of academic medical centers.
Performance status and disease stage emerged as critical predictors of surgical success, with patients having excellent performance status (0-1) and stage IIIA disease achieving surgical rates closer to 75%, comparable to clinical trial outcomes. However, patients with a performance status of 2 or stage IIIB to IIIC disease showed concerning surgical completion rates below 50%, raising questions about appropriate patient selection and the need for alternative treatment strategies. These findings emphasize the importance of thorough up-front evaluation by multidisciplinary teams before initiating neoadjuvant therapy.
The data underscore the critical importance of ensuring that patients starting neoadjuvant chemoimmunotherapy have been evaluated by thoracic surgeons and have clear surgical plans established before treatment initiation. This real-world evidence supports the development of standardized pathways for patient evaluation and treatment coordination, particularly in community settings where multidisciplinary infrastructure may be less robust. The findings advocate for enhanced communication networks and possibly centralized consultation processes to ensure optimal patient selection and treatment delivery across all practice settings.
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