Neoadjuvant Chemoimmunotherapy Followed by Surgery for Non-Small Cell Lung Cancer: Current Evidence and Unmet Needs

Abstract Objectives Neoadjuvant chemoimmunotherapy (nCIT) has rapidly emerged as a transformative treatment strategy for resectable non-small cell lung cancer. This review summarizes current clinical evidence, surgical considerations and ongoing challenges in incorporating nCIT into clinical practice. Methods A narrative review of pivotal phase II–III clinical trials was conducted, including CheckMate 816, KEYNOTE-671, AEGEAN and CheckMate 77 T, as well as recent meta-analyses and real-world evidence. Outcomes such as pathological complete response, major pathological response, event-free survival and surgical safety were evaluated. Key controversies—including patient selection, biomarker utility, surgical complexity and the role of adjuvant immunotherapy—were also examined. Results Phase III trials consistently demonstrated that nCIT improves pathological complete response, major pathological response and event-free survival compared with chemotherapy alone, without inc