Neoadjuvant Concurrent Chemo-Immuno-Radiation Therapy Followed by Surgery and Adjuvant Immunotherapy for Resectable Stage III N2 NSCLC: Primary Results From the SQUAT Trial (WJOG 12119L)

The recent CheckMate 816 trial indicated that neoadjuvant chemo-immunotherapy provided limited local control in stage II–III resectable non-small cell lung cancer (NSCLC). This trial evaluated the hypothesis that incorporating radiotherapy into the treatment plan—involving carboplatin and paclitaxel chemotherapy with neoadjuvant and adjuvant durvalumab—would lead to improved outcomes.  Among 31 patients treated, the major pathologic response (MPR) rate was 63 percent, surpassing the primary endpoint, with a pathologic complete response (pCR) rate of 23 percent. At a median follow-up of 28 months, the two-year progression-free and overall survival rates were 43 percent and 76 percent, respectively. Grade 3 or 4 adverse events occurred in 48 percent of patients, including one treatment-related death.  While this regimen achieved a higher MPR compared to recent perioperative chemo-immunotherapy trials, this did not translate into improved progression-free or overall survival outcomes.