D-BACE plus chemotherapy and camrelizumab for resectable stage II–IIIA and potentially resectable T3–4N2 IIIB non-small cell lung cancer

Inclusion Criteria:

Only patients who meet all of the following criteria are eligible for inclusion in this study:

Provide written informed consent Male or female, aged 18 to 75 years Eastern Cooperative Oncology Group (ECOG) performance status ≤1 Measurable disease in accordance with RECIST version 1.1

Subjects must be able to provide a specimen containing tumor tissue or have a newly resected tumor biopsy sample available for PD-L1 immunohistochemistry (IHC) testing at a central laboratory during the screening phase:

Before treatment, formalin-fixed, paraffin-embedded (FFPE) tissue blocks or unstained tumor tissue sections and relevant pathology reports must be submitted for biomarker assessment. Tumor tissue specimens may be fresh or archived within 6 months before enrollment.

The tissue must be a core needle biopsy section, excisional biopsy section, or incisional biopsy section.

It is recommended that fresh paraffin sections (PD-L1 assay to be performed within 7 days of sectioning) be stored and transported in the dark.

It is recommended that fresh tissue be fixed in 10% neutral buffered formalin for 24 to 48 hours.

The patient's lung function or other organ function must be evaluated by a surgeon as adequate to tolerate local surgical treatment.

Adequate organ function assessment and laboratory screening must be performed within 7 days prior to initiation of therapy.

Reproductive status:

Women of childbearing potential must have a negative pregnancy test (serum or urine) within 72 hours before the start of treatment.

Women must be non-lactating. Female patients must use appropriate contraception during treatment and for 6 months after the last dose of treatment.

Male subjects must agree to use appropriate contraception during treatment and for 7 months after the last dose of treatment, and must be willing to avoid donating sperm during this period.

Exclusion Criteria:

Medical conditions Stage I, IIIB/IIIC (N3), and stage IV NSCLC. Patients with previous immune checkpoint inhibitor (ICI) immunotherapy, targeted therapy, chemotherapy, or other systemic antitumor therapies.

Patients with brain metastases. Patients with allergy to contrast media. Patients whose tumors have targeted alterations in EGFR and/or ALK, or known targeted alterations in ROS1, BRAF, HER-2, NTRK, MET, or RET. Patients with K-RAS mutations are eligible.

Active known or suspected autoimmune disease. Subjects are eligible if they have type 1 diabetes, hypothyroidism requiring only hormone replacement therapy, skin conditions (e.g., vitiligo, psoriasis, or alopecia) not requiring systemic treatment, or other conditions not expected to recur in the absence of an external trigger.

Patients with active hepatitis B (positive hepatitis B surface antigen \[HBsAg\] test) or hepatitis C (positive HCV RNA test). Patients with previous HBV infection or resolved HBV infection (defined as positive hepatitis B core antibody \[HBcAb\] and negative HBsAg) are eligible to participate; these patients must provide HBV DNA test results before enrollment. Patients who are HBV carriers or require antiviral therapy are not eligible. Patients who test positive for HCV antibodies are eligible only if they have negative HCV RNA by PCR.

Patients with a history of human immunodeficiency virus (HIV) positivity or acquired immunodeficiency syndrome (AIDS).

Any history of arterial thrombosis within 6 months. History of deep vein thrombosis, pulmonary embolism, or any other serious thromboembolism within 3 months.

Uncontrolled angina, arrhythmia, or congestive heart failure. Other active malignancy within 5 years (except adequately treated carcinoma in situ of the cervix, basal cell or squamous cell skin cancer, superficial bladder cancer, prostate cancer, or breast carcinoma in situ).

Patients with contraindications to local treatment (including surgery or intervention) as judged by the investigator.

Serious or uncontrolled medical illness. Patients with psychosis or other conditions resulting in treatment nonadherence.

History of severe hypersensitivity reactions to other monoclonal antibodies. Patients who are unwilling to sign the informed consent form. Patients who are unwilling to undergo follow-up. Physical and laboratory examinations

Laboratory screening values must not meet any of the following criteria (CTCAE version 5.0 applies):

Bone marrow function:

White blood cell count \< 2,000/μL Neutrophil count \< 1,500/μL Platelet count \< 100 × 10³/μL Hemoglobin \< 9.0 g/dL

Liver function:

Serum total bilirubin \> 1.5 times the upper limit of normal (ULN) In the presence of liver metastases, AST and ALT \> 5 × ULN, and total bilirubin \> 1.5 × ULN

Coagulation function:

Abnormal coagulation function defined as international normalized ratio (INR) or prothrombin time (PT) \> 1.5 × ULN; if the subject is receiving anticoagulant therapy, PT must be outside the intended therapeutic range of the anticoagulant drug.

Renal function:

Urine protein \> 2+, or 24-hour urinary protein ≥ 1 g Serum creatinine \> 1.5 × ULN, or calculated creatinine clearance (CrCl) \< 50 mL/min (using the Cockcroft-Gault formula) Female CrCl = (\[140 - age\] × weight \[kg\] × 0.85) / (72 × serum creatinine \[mg/dL\]) Male CrCl = (\[140 - age\] × weight \[kg\] × 1.00) / (72 × serum creatinine \[mg/dL\]) Allergy and drug hypersensitivity History of hypersensitivity to other monoclonal antibodies. History of allergic or hypersensitivity reactions to components of the study drugs.

Other exclusion criteria Prisoners or subjects under compulsory confinement. Subjects involuntarily detained for treatment of mental or physical illness (e.g., infectious disease).