This post hoc analysis of the Neotorch phase 3 RCT evaluated perioperative toripalimab (240 mg) plus platinum-based chemotherapy vs placebo plus chemotherapy (3 cycles pre-surgery, 1 post-surgery, then 13 cycles maintenance) on surgical outcomes in 314 patients with resectable stage IIIA/IIIB NSCLC across 50 centers in China.
Surgery cancellation was significantly lower with toripalimab (17.8% vs 26.7%; P=.03). Tumor downstaging occurred in 80.7% vs 50.7% (P<.001) and lymph node downstaging in 67.5% vs 48.6% (P=.001). At median follow-up of 18.3 months, tumor and lymph node downstaging in the toripalimab group each correlated with superior EFS vs non-downstaging (median EFS not estimable vs 17.5 months, P=.004; and NE vs 19.2 months, P=.001). Surgical complication rates were similar between groups.
- Post hoc analysis limits causal inference. - Trial conducted exclusively in China, which may limit generalizability. - Median follow-up of 18.3 months is relatively short; EFS data not yet mature (median EFS not estimable in key subgroups).
Adding toripalimab to perioperative chemotherapy in resectable stage III NSCLC significantly improves tumor and lymph node downstaging without increasing surgical complications, and reduces surgery cancellation rates. Downstaging achieved with toripalimab translates to better event-free survival compared to downstaging with chemotherapy alone.
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