Prospective trial of immuno(chemo)therapy before resection, definitive chemoradiotherapy or palliative therapy in patients with locally advanced or oligometastatic non-small cell lung cancer without a primary curative option.
Aged
Aged, 80 and over
Antibodies, Monoclonal, Humanized
/ adverse effects
Antineoplastic Combined Chemotherapy Protocols
/ adverse effects
Carcinoma, Non-Small-Cell Lung
/ drug therapy
Chemoradiotherapy
/ adverse effects
Chemotherapy, Adjuvant
Female
Germany
Humans
Immune Checkpoint Inhibitors
/ adverse effects
Lung Neoplasms
/ drug therapy
Male
Middle Aged
Neoadjuvant Therapy
/ adverse effects
Nivolumab
/ adverse effects
Palliative Care
Pneumonectomy
/ adverse effects
Prospective Studies
Time Factors
Treatment Outcome
Checkpoint inhibitor
NSCLC
PD-L1
Real-world
Survival
Journal
European journal of cancer (Oxford, England : 1990)
ISSN: 1879-0852
Titre abrégé: Eur J Cancer
Pays: England
ID NLM: 9005373
Informations de publication
Date de publication:
10 2021
10 2021
Historique:
received:
29
06
2021
accepted:
21
07
2021
pubmed:
31
8
2021
medline:
23
11
2021
entrez:
30
8
2021
Statut:
ppublish
Résumé
Recent phase II-III trials of immuno(chemo)therapy before resection in locally advanced resectable non-small cell lung cancer (NSCLC) report high rates of pathological response and promising survival. However, primarily, patients who did not undergo resection were excluded from these studies. Moreover, there are no data on chemoradiotherapy (CRT) after immuno(chemo)therapy in patients who are primarily not amenable to CRT. We hypothesised that induction immuno(chemo)therapy may enable patients with NSCLC with a potentially curative stage (III-IVA), for whom primary curative treatment (either resection or CRT) is not possible for anatomical or functional reasons, to receive curative treatment. We enrolled 35 patients with NSCLC with aforementioned characteristics into a prospective real-world trial of induction immuno(chemo)therapy followed by morphologic and metabolic reassessment and multidisciplinary board-guided curative treatment (resection [preferred] or CRT) or palliative therapy. The primary end-point was the proportion of patients receiving curative treatment. Thirty-two patients (91%) received curative treatment (11 resections and 21 CRT). 73% and 64% of patients who underwent resection had a major or complete pathological response, respectively. There were 14 recurrences: 2 (18%) in patients who underwent resection, 9 (43%) in patients who received CRT and 3 (100%) in patients who received palliative therapy (median follow-up 17 months). Eight tumour-related deaths occurred: 5 (24%) in patients who received CRT; and 3 (100%) in patients who received palliative therapy. There were no treatment-related deaths. In locally advanced or oligometastatic NSCLC without a primary curative option, induction immuno(chemo)therapy results in a high rate of curative treatment with promising early survival data. patients who underwent resection achieved a high rate of prognostically favourable pathological response.
Sections du résumé
BACKGROUND
Recent phase II-III trials of immuno(chemo)therapy before resection in locally advanced resectable non-small cell lung cancer (NSCLC) report high rates of pathological response and promising survival. However, primarily, patients who did not undergo resection were excluded from these studies. Moreover, there are no data on chemoradiotherapy (CRT) after immuno(chemo)therapy in patients who are primarily not amenable to CRT. We hypothesised that induction immuno(chemo)therapy may enable patients with NSCLC with a potentially curative stage (III-IVA), for whom primary curative treatment (either resection or CRT) is not possible for anatomical or functional reasons, to receive curative treatment.
PATIENTS AND METHODS
We enrolled 35 patients with NSCLC with aforementioned characteristics into a prospective real-world trial of induction immuno(chemo)therapy followed by morphologic and metabolic reassessment and multidisciplinary board-guided curative treatment (resection [preferred] or CRT) or palliative therapy. The primary end-point was the proportion of patients receiving curative treatment.
RESULTS
Thirty-two patients (91%) received curative treatment (11 resections and 21 CRT). 73% and 64% of patients who underwent resection had a major or complete pathological response, respectively. There were 14 recurrences: 2 (18%) in patients who underwent resection, 9 (43%) in patients who received CRT and 3 (100%) in patients who received palliative therapy (median follow-up 17 months). Eight tumour-related deaths occurred: 5 (24%) in patients who received CRT; and 3 (100%) in patients who received palliative therapy. There were no treatment-related deaths.
CONCLUSIONS
In locally advanced or oligometastatic NSCLC without a primary curative option, induction immuno(chemo)therapy results in a high rate of curative treatment with promising early survival data. patients who underwent resection achieved a high rate of prognostically favourable pathological response.
Identifiants
pubmed: 34461420
pii: S0959-8049(21)00493-7
doi: 10.1016/j.ejca.2021.07.035
pii:
doi:
Substances chimiques
Antibodies, Monoclonal, Humanized
0
Immune Checkpoint Inhibitors
0
Nivolumab
31YO63LBSN
pembrolizumab
DPT0O3T46P
Types de publication
Clinical Study
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
175-186Informations de copyright
Copyright © 2021 Elsevier Ltd. All rights reserved.
Déclaration de conflit d'intérêts
Conflict of interest statement The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: MF has received speaker's honoraria and served on advisory boards of AstraZeneca, BMS, MSD and Roche and is the principle investigator of phase II–III clinical studies by AstraZeneca, BMS, MSD and Roche. SK has received speaker's honoraria Roche. The other authors have declared no conflict of interest to disclose.