Predictors, surrogate, and patient-reported outcomes in immunotherapy and salvage surgery for unresectable lung cancer: a single-center retrospective study.
Immuno-oncology
Lung cancer
Patient-reported outcomes
Predictive study
Journal
Updates in surgery
ISSN: 2038-3312
Titre abrégé: Updates Surg
Pays: Italy
ID NLM: 101539818
Informations de publication
Date de publication:
Dec 2023
Dec 2023
Historique:
received:
12
05
2023
accepted:
28
08
2023
pubmed:
5
9
2023
medline:
5
9
2023
entrez:
5
9
2023
Statut:
ppublish
Résumé
Medical treatment has changed drastically in recent years, especially for advanced stages of non-small-cell lung cancer (NSCLC), for which the development of immunotherapy and molecular targeted therapy significantly increased survival and quality of life. This single-center retrospective study aimed to analyze the outcome predictors, the surrogate outcomes, and the patient-reported outcomes after neoadjuvant immunotherapy for initially unresectable NSCLC. Patients affected by an initially unresectable NSCLC and identified between March 2014 and December 2021 who received immunotherapy alone or in combination with platinum-based chemotherapy and/or radiotherapy were collected. Overall survival (OS) and disease-free survival (DFS) were estimated according to the Kaplan-Meier method. Patient-reported outcomes were recorded using the European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life (QoL) Group questionnaire-Lung Cancer 29 Module to compare differences in symptoms and QoL at two different times, 30 days and 1 year after surgery. Surgical, pathological records, and patient-reported outcomes (at 30 days and 1 year after surgery) were reviewed. Complete pathological remission was achieved in 7 patients (36.8%) and major pathological remission in 3 patients (15.7%). The median overall survival in the study group is 19 months (range: 2-57.4). Of 19 patients, 16 (84.2%) are alive to date, of which 2 (10.5%) have a local recurrence. At 30 days from surgery, the main symptoms reported by EORTC Module were coughing, shortness of breath, the side effect of treatment, fear of progression, and surgery-related problems. Induction immunotherapy with or without chemotherapy can be considered for unresectable locally advanced NSCLC, and after the downstaging, the possibility of surgery could be re-evaluated in a multidisciplinary setting with high rates of R0 resection. In this selected and highly motivated group of patients, the QoL and symptoms after salvage surgeries are acceptable and even better than those reported in the literature.
Identifiants
pubmed: 37668890
doi: 10.1007/s13304-023-01644-y
pii: 10.1007/s13304-023-01644-y
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2355-2363Subventions
Organisme : Ministero della Salute
ID : 5 x 1000
Organisme : Ministero della Salute
ID : Ricerca Corrente
Informations de copyright
© 2023. Italian Society of Surgery (SIC).
Références
Bertolaccini L, Mohamed S, Bardoni C, Lo Iacono G, Mazzella A, Guarize J, Spaggiari L (2022) The interdisciplinary management of lung cancer in the European community. J Clin Med. https://doi.org/10.3390/jcm11154326
doi: 10.3390/jcm11154326
pubmed: 36555972
pmcid: 9781100
Pöttgen C, Eberhardt W, Stamatis G, Stuschke M (2017) Definitive radiochemotherapy versus surgery within multimodality treatment in stage III non-small cell lung cancer (NSCLC)—a cumulative meta-analysis of the randomized evidence. Oncotarget 8(25):41670–41678
doi: 10.18632/oncotarget.16471
pubmed: 28415831
pmcid: 5522187
Nakagawa K, Watanabe SI, Kunitoh H, Asamura H (2017) The lung cancer surgical study group of the japan clinical oncology group: past activities, current status and future direction. Jpn J Clin Oncol 47:194–199
doi: 10.1093/jjco/hyw169
pubmed: 28365781
Paez JG, Jänne PA, Lee JC, Tracy S, Greulich H, Gabriel S, Herman P, Kaye FJ, Lindeman N, Boggon TJ, Naoki K, Sasaki H, Fujii Y, Eck MJ, Sellers WR, Johnson BE (2004) EGFR mutations in lung cancer: correlation with clinical response to gefitinib therapy. Meyerson MSci 304(5676):1497–1500
Kwak EL, Bang YJ, Camidge DR, Shaw AT, Solomon B, Maki RG, Ou SH, Dezube BJ, Jänne PA, Costa DB, Varella-Garcia M, Kim WH, Lynch TJ, Fidias P, Stubbs H, Engelman JA, Sequist LV, Tan W, Gandhi L, Mino-Kenudson M, Wei GC, Shreeve SM, Ratain MJ, Settleman J, Christensen JG, Haber DA, Wilner K, Salgia R, Shapiro GI, Clark JW, Iafrate AJ (2010) Anaplastic lymphoma kinase inhibition in non-small-cell lung cancer. N Engl J Med 363(18):1693–1703
doi: 10.1056/NEJMoa1006448
pubmed: 20979469
pmcid: 3014291
Shaw AT, Ou SH, Bang YJ, Camidge DR, Solomon BJ, Salgia R, Riely GJ, Varella-Garcia M, Shapiro GI, Costa DB, Doebele RC, Le LP, Zheng Z, Tan W, Stephenson P, Shreeve SM, Tye LM, Christensen JG, Wilner KD, Clark JW, Iafrate AJ (2014) Crizotinib in ROS1-rearranged non-small-cell lung cancer. N Engl J Med 371(21):1963–1971
doi: 10.1056/NEJMoa1406766
pubmed: 25264305
pmcid: 4264527
Zhong WZ, Chen KN, Chen C, Gu CD, Wang J, Yang XN, Mao WM, Wang Q, Qiao GB, Cheng Y et al (2019) Erlotinib versus gemcitabine plus cisplatin as neoadjuvant treatment of stage IIIA-N2 EGFR-mutant non-small-cell lung cancer (EMERGING-CTONG 1103): a randomized phase II study. J Clin Oncol 37:2235–2245
doi: 10.1200/JCO.19.00075
pubmed: 31194613
Bott MJ, Yang SC, Park BJ, Adusumilli PS, Rusch VW, Isbell JM, Downey RJ, Brahmer JR, Battafarano R, Bush E et al (2019) Initial results of pulmonary resection after neoadjuvant nivolumab in patients with resectable non-small cell lung cancer. J Thorac Cardiovasc Surg 158:269–276
doi: 10.1016/j.jtcvs.2018.11.124
pubmed: 30718052
Chaft JE, Hellmann D, Velez MJ, Travis WD, Rusch VW (2017) Initial experience with lung cancer resection after treatments with T-cell checkpoint inhibitors. Ann Thorac Surg 104:e217–e218
doi: 10.1016/j.athoracsur.2017.03.038
pubmed: 28838509
pmcid: 5572805
Passaglia F, Bertolaccini L, Del Re M et al (2019) Diagnosis and treatment of early and locally advanced non-small cell lung cancer: the 2019 AIOM (Italian association of medical oncology) clinical practice guidelines. Crit Rev Oncol Hematol. https://doi.org/10.1016/j.critrevonc.2019.102862
doi: 10.1016/j.critrevonc.2019.102862
Suh JH, Johnson A, Albacker L, Wang K, Chmielecki J, Frampton G, Gay L, Elvin JA, Vergilio JA, Ali S, Miller VA, Stephens PJ, Ross JS (2016) Comprehensive genomic profiling facilitates implementation of the national comprehensive cancer network guidelines for lung cancer biomarker testing and identifies patients who may benefit from enrollment in mechanism-driven clinical trials. Oncologist 21(6):684–691
doi: 10.1634/theoncologist.2016-0030
pubmed: 27151654
pmcid: 4912374
Gray JE, Villegas A, Daniel D et al (2020) Three-year overall survival with durvalumab after chemo-radiotherapy in stage III NSCLC-update from PACIFIC. J Thorac Oncol 15:288–293
doi: 10.1016/j.jtho.2019.10.002
pubmed: 31622733
Agha R, Abdall-Razak A, Crossley E, Dowlut N, Iosifidis C, Mathew G, Group, S (2019) STROCSS 2019 guideline: strengthening the reporting of cohort studies in surgery. Int J Surg 72:156–165. https://doi.org/10.1016/j.ijsu.2019.11.002
doi: 10.1016/j.ijsu.2019.11.002
pubmed: 31704426
Travis WD, Dacic S, Wistuba I et al (2020) IASLC multidisciplinary recommendations for pathologic assessment of lung cancer resection specimens after neoadjuvant therapy. J Thorac Oncol 15:709–740
doi: 10.1016/j.jtho.2020.01.005
pubmed: 32004713
pmcid: 8173999
Hellmann MD, Chaft JE, William WN Jr et al (2014) Pathological response after neoadjuvant chemotherapy in resectable non-small-cell lung cancers: proposal for the use of major pathological response as a surrogate endpoint. Lancet Oncol 15:e42-50
doi: 10.1016/S1470-2045(13)70334-6
pubmed: 24384493
pmcid: 4734624
Koller M, Hjermstad MJ, Tomaszewski KA, Tomaszewska IM, Hornslien K, Harle A, Arraras JI, Morag O, Pompili C, Ioannidis G, Georgiou M, Navarra C, Chie WC, Johnson CD, Himpel A, Schulz C, Bohrer T, Janssens A, Kulis D, Bottomley A, EORTC Quality of Life Group, EORTC Lung Cancer Group, and European Society of Thoracic Surgeons (2017) An international study to revise the EORTC questionnaire for assessing quality of life in lung cancer patients. Ann Oncol 28(11):2874–2881. https://doi.org/10.1093/annonc/mdx453 . (PubMed PMID: 28945875)
doi: 10.1093/annonc/mdx453
pubmed: 28945875
Team, R (2021) RStudio: integrated development environment for R. RStudio Inc, Boston
Team, RC (2021) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna
Nawashiro A, Tanaka F, Taira A, Shinohara S, Takenaka M, Kuroda K, Shimajiri S (2022) Salvage surgery following immuno-chemo-radiotherapy for advanced non-small cell lung cancer. Surg Case Rep 8:17. https://doi.org/10.1186/s40792-022-01371-3
doi: 10.1186/s40792-022-01371-3
pubmed: 35061129
pmcid: 8782972
Minegishi K, Tsubochi H, Ohno K, Komori K, Ozeki M, Endo S (2021) Salvage surgery post definitive chemo-radiotherapy and durvalumab for lung cancer. Ann Thorac Surg 112:e53–e55
doi: 10.1016/j.athoracsur.2020.09.083
pubmed: 33373589
Jiang L, Huang J, Li C, Shen Y, Zhang Y, Lu S, Luo Q (2020) Immuno-based therapeutic strategies for initial unresectable locally advanced non-small cell lung cancer: a case report. Transl Lung Cancer Res 9(3):803–806. https://doi.org/10.21037/tlcr-20-517
doi: 10.21037/tlcr-20-517
pubmed: 32676341
pmcid: 7354105
Li L, Chen T, Lai H, Zhang A, Zhao X, Wu J, Hong H, Wu L, Lin S, Wang K, Zhang H, Fang C (2022) Case report: pathological complete response in an IIIB non-small cell lung cancer patient after preoperative neoadjuvant nivolumab therapy combined with chemotherapy. Medicine 101:23(e29336)
pubmed: 35687776
Ma D, Xu Y, Qin Y, Li S, Li J, Jiang Y, Wang M, Xu Y, Zhao J, Chen M, Cheng W, Hu K, Liu H (2022) Neoadjuvant immunotherapy followed by surgery with curative intent in 35 patients with advanced NSCLC: the retrospective experiences of a multidisciplinary team. Ann Transl Med 10(10):609. https://doi.org/10.21037/atm-22-2271
doi: 10.21037/atm-22-2271
pubmed: 35722361
pmcid: 9201164
Deng H, Liu J, Cai X, Chen J, Rocco G, Petersen RH, Brunelli A, Ng CSH, D’Amico TA, Liang W, He J (2022) Radical minimally invasive surgery after immuno-chemotherapy in initially-unresectable stage IIIB non-small cell lung cancer. Ann Surg. https://doi.org/10.1097/SLA.0000000000005233
doi: 10.1097/SLA.0000000000005233
pubmed: 35848748
Galetta D, De Marinis F, Spaggiari L (2022) Rescue surgery after immunotherapy/tyrosine kinase inhibitors for initially unresectable lung cancer. Cancers 14:2661. https://doi.org/10.3390/cancers14112661
doi: 10.3390/cancers14112661
pubmed: 35681639
pmcid: 9179896
Ueno T, Yamashita M, Yamashita N, Uomoto M, Kawamata O, Sano Y, Inokawa H, Hirayama S, Okazaki M, Toyooka S (2022) Safety of salvage lung resection after immunotherapy for unresectable non-small cell lung cancer. Gen Thorac Cardiovasc Surg 70(9):812–817. https://doi.org/10.1007/s11748-022-01798-3 . (Epub 2022 March 19th PMID: 35304712)
doi: 10.1007/s11748-022-01798-3
pubmed: 35304712
Travis WD, Dacic S, Wistuba I et al (2020) IASLC multidisciplinary recommendations for pathologic assessment of lung cancer resection specimens after neoadjuvant therapy. J Thorac Oncol 15:709–740
doi: 10.1016/j.jtho.2020.01.005
pubmed: 32004713
pmcid: 8173999
Liang W, Cai K, Chen C, Chen H, Chen Q, Fu J, Hu J, Jiang T, Jiao W, Li S, Liu C, Liu D, Liu W, Liu Y, Ma H, Pan X, Qiao G, Tian H, Wei L, Zhang Y, Zhao S, Zhao X, Zhou C, Zhu Y, Zhong R, Li F, Rosell R, Provencio M, Massarelli E, Antonoff MB, Hida T, de Perrot M, Lin SH, Di Maio M, Rossi A, De Ruysscher D, Ramirez RA, Dempke WCM, Camidge DR, Guibert N, Califano R, Wang Q, Ren S, Zhou C, He J (2020) Expert consensus on neoadjuvant immunotherapy for non-small cell lung cancer. Transl Lung Cancer Res 9(6):2696–2715. https://doi.org/10.21037/tlcr-2020-63 . (PMID: 33489828; PMCID: PMC7815365)
doi: 10.21037/tlcr-2020-63
pubmed: 33489828
pmcid: 7815365
Ettinger DS, Wood DE, Aggarwal C et al (2019) NCCN guidelines insights: non-small cell lung cancer, version 1.2020. J Natl Compr Canc Netw 17:1464–72
doi: 10.6004/jnccn.2019.0059
pubmed: 31805526
Kar P, Sudheshna KD, Padmaja D, Pathy A, Gopinath R (2019) Chronic pain following thoracotomy for lung surgeries: it’s risk factors, prevalence, and impact on quality of life—a retrospective study. Indian J Anaesth 63:368–374
doi: 10.4103/ija.IJA_42_19
pubmed: 31142880
pmcid: 6530277
Pompili C, Trevis J, Patella M, Brunelli A, Libretti L, Novoa N et al (2021) European society of thoracic surgeons electronic quality of life application after lung resection: field testing in a clinical setting. Interact CardioVasc Thorac Surg 32:911–920
doi: 10.1093/icvts/ivab030
pubmed: 33909903
pmcid: 8691569