Immunotherapy Before Surgery Helps More Stage III Lung Cancer Patients Become Operable, Trial Finds

Stage III non-small cell lung cancer (NSCLC) that has spread to lymph nodes in the center of the chest — often called N2+ disease — has traditionally been difficult to treat, in part because it can be hard to fully remove surgically. A new multi-institution trial suggests that treatment sequencing may make a meaningful difference.

The AFT-46/CHIO3 study, conducted by Alliance Foundation Trials across nine institutions in Illinois, Massachusetts, New York, Tennessee, and Virginia between 2021 and 2023, tested giving chemotherapy together with the immunotherapy drug durvalumab before surgery, with the goal of shrinking tumors enough to make complete surgical removal possible. Patients who went on to surgery then continued durvalumab for one additional year afterward.

Results showed that 81% of enrolled patients were able to undergo surgery after the combined pre-surgical treatment, and among those who had surgery, nearly three-quarters (73%) had their cancer completely cleared from the affected lymph nodes. Lead investigator Linda W. Martin, MD, MPH, a professor of thoracic surgery at the University of Virginia, described the results as offering "a new, successful blueprint" for a stage of disease that has traditionally been difficult to manage.

Neoadjuvant (before-surgery) treatment strategies are an increasingly active research category across lung cancer overall. Track how many trials are currently studying pre-surgical and combination approaches using our live Research Progress Tracker.