# Comparative Efficacy of PD‐1 Inhibitor‐Based Neoadjuvant Chemoimmunotherapy Regimens for Resectable Stage II–IIIa NSCLC: A Real‐World Retrospective Study

## TL;DR

This study compares the effectiveness and safety of four PD-1 inhibitors in treating early-stage lung cancer, finding that pembrolizumab and tislelizumab offer the best balance of survival and fewer side effects.

## Contribution

The study provides real-world comparative data on PD-1 inhibitors in neoadjuvant therapy for resectable NSCLC, highlighting survival and safety differences.

## Key findings

- Pembrolizumab and tislelizumab showed significantly better overall survival compared to other PD-1 inhibitors.
- Tislelizumab had the lowest rate of severe treatment-related adverse events.
- All four PD-1 inhibitors achieved high pathological response rates in patients with resectable NSCLC.

## Abstract

Although neoadjuvant chemoimmunotherapy has emerged as a promising approach for resectable non‐small cell lung cancer (NSCLC), comparative real‐world data on different PD‐1 inhibitors are limited. This study compared the clinical efficacy, pathological response, survival, and safety of four PD‐1 inhibitors—pembrolizumab, tislelizumab, camrelizumab, and sintilimab—in patients with Stage II–IIIa NSCLC.

We retrospectively reviewed 199 patients with resectable Stage II–IIIa NSCLC treated with neoadjuvant PD‐1 inhibitors plus platinum‐based chemotherapy from January 2018 to December 2024. After excluding 50 non‐surgical cases, 149 patients were included. Outcomes compared included pathological response (pathological complete response, pCR; major pathological response, MPR), recurrence, disease‐free survival (DFS), overall survival (OS), and adverse events.

pCR and MPR rates were 52.2% and 58.0% (pembrolizumab), 67.6% and 75.7% (tislelizumab), 71.4% and 71.4% (camrelizumab), and 47.2% and 61.1% (sintilimab), respectively. Differences in pCR/MPR were not statistically significant. However, OS differed significantly across groups (p < 0.05), favoring pembrolizumab and tislelizumab. No significant differences were observed in progression‐free survival (PFS) or recurrence among patients with pCR. Grade ≥ 3 treatment‐related adverse events occurred in 27.0%–42.9% of patients, lowest in the tislelizumab group.

All treatment regimens elicited substantial pathological responses and exhibited acceptable safety profiles. Pembrolizumab and tislelizumab were associated with better OS and lower toxicity, supporting their preferential use in neoadjuvant therapy for resectable NSCLC.

In 149 real‐world patients with resectable Stage II–IIIa NSCLC, neoadjuvant PD‐1 inhibitors (pembrolizumab, tislelizumab, camrelizumab, and sintilimab) plus platinum chemotherapy achieved pCR rates of 47.2%–71.4% with Grade ≥ 3 TRAEs ranging from 27.0%–42.9%. Tislelizumab (HR: 0.167) and sintilimab (HR: 0.090) were associated with superior OS compared with pembrolizumab (reference); camrelizumab showed a nonsignificant trend. Pembrolizumab and tislelizumab demonstrated a favorable balance of efficacy and safety, supporting their preferential use in the neoadjuvant setting.