(Near-)complete pathological response after neoadjuvant treatment with chemotherapy and nivolumab

Introduction: The neoadjuvant and adjuvant treatment of localized lung cancer has evolved significantly in recent years, incorporating therapeutic strategies with meaningful clinical impact. Case report: We present the case of a 71-year-old male with a history of arterial hypertension, type 2 diabetes mellitus, dyslipidemia, moderate COPD under bronchodilator treatment, and adrenalectomy in 2023 due to a functioning adenoma with secondary Cushing’s syndrome. A former smoker for the past nine years, with a 45 pack-year history. He was diagnosed with squamous cell carcinoma of the left upper lobe, stage IIIA (T2N2M0), with PD-L1 expression of 95%. He received neoadjuvant treatment with carboplatin, paclitaxel, and nivolumab (CHECKMATE 816), achieving a partial vs. complete morphometabolic response. Subsequently, a left upper lobectomy with mediastinal lymphadenectomy was performed, achieving negative margins (R0). The pathological study revealed a ypT0 ypN2 stage, with micrometastasis in one subaortic lymph node. Conclusion: In light of the findings from the CHETMATE 77T, KEYNOTE 671, and AEGEAN studies, the following question arises… Could the patient benefit from any adjuvant treatment considering the postoperative pathological result?