Durvalumab (PD-L1) + neoadjuvant chemo lifts pCR across lobectomy/sleeve/pneumonectomy in resectable NSCLC

Perioperative durvalumab, an anti–PD-L1 monoclonal antibody, was evaluated in AEGEAN, a double-blind Phase 3 trial (NCT03800134) in treatment-naïve, resectable stage II–IIIB (N2) NSCLC excluding EGFR/ALK-altered tumors (mITT). Among patients who underwent surgery (durvalumab n=295; placebo n=302), pCR improved with durvalumab regardless of operation—lobectomy 21.0% vs 5.4%, sleeve resection/bilobectomy 36.4% vs 5.4%, pneumonectomy 7.4% vs 3.4%—and EFS favored durvalumab across subgroups (HR 0.64, 0.59, and 0.80, respectively). Grade ≥3 surgical complications were uncommon and broadly similar (lobectomy 4.2% vs 9.5%; sleeve/bilobectomy 13.6% vs 5.4%; pneumonectomy 14.8% vs 6.9%); relative to “chemo-only” neoadjuvant standards (pCR typically low single digits, e.g., 2.2% with chemo alone in CheckMate 816), these pCR deltas look clinically meaningful even if EFS precision is limited in the smaller sleeve/pneumonectomy strata.