MDT-BRIDGE: primary analysis

The primary analysis of the phase II MDT-BRIDGE trial evaluated an individualised, multidisciplinary team (MDT)-guided treatment strategy for patients with resectable or borderline resectable stage IIB–IIIB NSCLC. This global, non-randomised study enrolled patients with previously untreated, EGFR/ALK wild-type disease who were suitable for multimodal treatment. Following an initial MDT assessment of resectability, patients received two cycles of neoadjuvant durvalumab plus platinum-based chemotherapy. A second MDT assessment determined the subsequent treatment pathway. Patients considered resectable received one or two additional cycles of chemoimmunotherapy before surgery, followed by adjuvant durvalumab. Patients deemed unresectable proceeded to definitive chemoradiotherapy, followed by consolidation durvalumab. The primary endpoint was the overall resection rate; secondary endpoints included surgical outcomes, efficacy and safety.

Overall, 142 patients received neoadjuvant treatment, including 50 who were classified as borderline resectable at baseline. The overall resection rate was 74.6%, while 25 patients received chemoradiotherapy. Together, these results indicate that approximately 92% of patients reached definitive local treatment with curative intent. Complete resection was achieved in more than 96% of resected patients. Preliminary survival findings were encouraging, with the reported one-year event-free survival estimate exceeding 82%; however, follow-up remained limited.

Safety was particularly relevant for patients proceeding to chemoradiotherapy and consolidation durvalumab after induction chemoimmunotherapy. No unexpected safety signal was reported, including no apparent increase in immune-mediated or pulmonary toxicity.

MDT-BRIDGE therefore provides preliminary support for a flexible treatment strategy in which initial chemoimmunotherapy is followed by reassessment to guide patients towards surgery or definitive chemoradiotherapy. This approach may be particularly relevant when resectability is uncertain at diagnosis and highlights the importance of repeated multidisciplinary evaluation throughout treatment. Nevertheless, the single-arm design and immature survival data preclude conclusions about superiority over established strategies. Further analyses are expected to clarify patient selection and longer-term outcomes.