Fig. 1: CONSORT diagram and biospecimen collection schema.

a, CONSORT flow diagram depicting patient disposition as follows: 30 patients were screened and sequentially enrolled in the study; 16 patients were enrolled in Arm A and received neoadjuvant nivo; and 14 patients were enrolled in Arm B and received neoadjuvant nivo/ipi ×1 followed by neoadjuvant nivo. Disease progression precluded surgery for three patients in Arm A and two patients in Arm B; of the patients who proceeded to surgery, one patient in each arm was deemed to have unresectable disease intraoperatively. Twelve patients in Arm A and 11 patients in Arm B underwent complete macroscopic resection. In Arm A, nine patients received adjuvant chemotherapy, seven received adjuvant radiotherapy and eight received adjuvant immunotherapy. In Arm B, five patients received adjuvant chemotherapy, five patients received adjuvant radiotherapy and six patients received adjuvant immunotherapy. At the data cutoff date, one patient in Arm A was alive but experienced progression (14 deceased, one lost to follow-up), and eight patients in Arm B were alive, with five determined to be disease free (six deceased). PFS and OS analyses were conducted for all 30 patients in the study cohort. Post-surgery landmark analyses were conducted for 12 patients in Arm A and for 11 patients in Arm B. ORR analyses were conducted for 15 patients in Arm A and for 11 patients in Arm B; RECIST was not performed for one patient in each arm, and two patients in Arm B were not evaluable by RECIST. b, Biospecimen collection schema, depicting the sample collection schedule for the trial. Tumor tissue was collected at pretreatment biopsy and at resection. Serial plasma samples were collected at C1D1 (D–42), C2D1 (D–28), C3D1 (D–14), pre-surgery (D–3), post-surgery before adjuvant therapy initiation and longitudinally during and after adjuvant therapy until the time of recurrence. Created with BioRender.com. Adj., adjuvant; D, day.