Safety and Efficacy of Salvage Surgery after Treatment With Immune-Checkpoint Adjuvant Inhibitors for Advanced Non-Small Cell Lung Cancer: A Multicentric Study.
NSCLC
VATS
immunotherapy
Journal
Journal of surgical oncology
ISSN: 1096-9098
Titre abrégé: J Surg Oncol
Pays: United States
ID NLM: 0222643
Informations de publication
Date de publication:
24 Sep 2024
24 Sep 2024
Historique:
revised:
23
08
2024
received:
03
03
2024
accepted:
12
09
2024
medline:
25
9
2024
pubmed:
25
9
2024
entrez:
25
9
2024
Statut:
aheadofprint
Résumé
In advanced non-small cell lung cancer (NSCLC), immune-checkpoint inhibitors (ICIs) can achieve significant clinical responses. This raises the question of whether to consider salvage surgery as a curative treatment option. Few case series reported encouraging results in terms of pathological response. However, intraoperative risk and postoperative morbidity have been highlighted. This study aims to assess the safety and feasibility of surgery after ICIs administration and to evaluate its effectiveness on the final pathological examination. We retrospectively identified stages III-IVA NSCLC consecutive patients who underwent surgery with radical intent after ICIs at three National Centers (2016-2022). Before treatment, all patients were considered unresectable by a multidisciplinary discussion. After surgery, pathological response was evaluated according to the International Association for the Study of Lung Cancer (IASLC) recommendation. Thirty-one patients were included; pretreatment clinical stage was: IIIA in 4 patients (10%), IIIB in 13 (42%), IIIC in 3 (13%), and IVA in 11 (35%). Median treatment duration was four cycles. Only anatomical resections were performed, with lobectomy that represent the main type of resection (22 patients, 74%). A minimally invasive approach was performed in 10 patients (32%), with a conversion rate of 0%. Postoperative complications were observed in eight patients (25%). Complete pathologic response (CPR) and major pathologic response (MPR) were 48% and 16%, respectively. Two and 3-years survival were 88%. Based on our experience, salvage surgery of advanced NSCLC treated with ICIs confirm his feasibility and safety in responder patients. Moreover, it is associated with low morbidity, high CPR rate, and satisfying medium-term survival.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 The Author(s). Journal of Surgical Oncology published by Wiley Periodicals LLC.
Références
H. Sung, J. Ferlay, R. L. Siegel, et al., “Global Cancer Statistics 2020: Globocan Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries,” CA: A Cancer Journal for Clinicians 71, no. 3 (May 2021): 209–249.
T. Lu, X. Yang, Y. Huang, et al, “Trends in the Incidence, Treatment, and Survival of Patients With Lung Cancer in the Last Four Decades,” Cancer Management and Research 11 (2019): 943.
J. Remon, J. C. Soria, and S. Peters, “Early and Locally Advanced Non‐Small‐Cell Lung Cancer: An Update of the ESMO Clinical Practice Guidelines Focusing on Diagnosis, Staging, Systemic and Local Therapy,” Annals of Oncology 32, no. 12 (December 2021): 1637–1642.
M. Reck, D. Rodríguez–Abreu, A. G. Robinson, et al., “Updated Analysis of KEYNOTE‐024: Pembrolizumab Versus Platinum‐Based Chemotherapy for Advanced Non‐Small‐Cell Lung Cancer With PD‐L1 Tumor Proportion Score of 50% or Greater,” Journal of Clinical Oncology 37, no. 7 (March 2019): 537–546.
L. Gandhi, D. Rodríguez‐Abreu, S. Gadgeel, et al., “Pembrolizumab Plus Chemotherapy in Metastatic Non‐Small‐Cell Lung Cancer,” New England Journal of Medicine 378, no. 22 (May 2018): 2078–2092.
L. Paz‐Ares, D. Vicente, A. Tafreshi, et al., “A Randomized, Placebo‐Controlled Trial of Pembrolizumab Plus Chemotherapy in Patients With Metastatic Squamous NSCLC: Protocol‐Specified Final Analysis of KEYNOTE‐407,” Journal of Thoracic Oncology 15, no. 10 (October 2020): 1657–1669.
L. Paz‐Ares, T. E. Ciuleanu, M. Cobo, et al., “First‐Line Nivolumab Plus Ipilimumab Combined With Two Cycles of Chemotherapy in Patients With Non‐Small‐Cell Lung Cancer (CheckMate 9LA): An International, Randomised, Open‐Label, Phase 3 Trial,” Lancet Oncology 22, no. 2 (February 2021): 198–211.
J. E. Chaft, M. D. Hellmann, M. J. Velez, W. D. Travis, and V. W. Rusch, “Initial Experience With Lung Cancer Resection After Treatment With T‐Cell Checkpoint Inhibitors,” Annals of Thoracic Surgery 104, no. 3 (September 2017): e217–e218.
M. J. Bott, S. C. Yang, B. J. Park, et al., “Initial Results of Pulmonary Resection After Neoadjuvant Nivolumab in Patients With Resectable Non‐Small Cell Lung Cancer,” Journal of Thoracic and Cardiovascular Surgery 158, no. 1 (July 2019): 269–276.
M. Wislez, J. Mazieres, A. Lavole, et al., “Neoadjuvant Durvalumab for Resectable Non‐Small‐Cell Lung Cancer (NSCLC): Results From a Multicenter Study (IFCT‐1601 IONESCO),” Journal for Immunotherapy of Cancer 10, no. 10 (October 2022): e005636.
S. Hellman and R. R. Weichselbaum, “Oligometastases,” Journal of Clinical Oncology 13 (1995): 8–10.
W. D. Travis, H. Asamura, A. A. Bankier, et al., “The IASLC Lung Cancer Staging Project: Proposals for Coding T Categories for Subsolid Nodules and Assessment of Tumor Size in Part‐Solid Tumors in the Forthcoming Eighth Edition of the TNM Classification of Lung Cancer,” Journal of Thoracic Oncology 11, no. 8 (August 2016): 1204–1223.
P. De Leyn, C. Dooms, J. Kuzdzal, et al., “Revised ESTS Guidelines for Preoperative Mediastinal Lymph Node Staging for Non‐Small‐Cell Lung Cancer,” European Journal of Cardio‐Thoracic Surgery 45, no. 5 (May 2014): 787–798.
A. G. Nicholson, M. S. Tsao, M. B. Beasley, et al., “The 2021 WHO Classification of Lung Tumors: Impact of Advances Since 2015,” Journal of Thoracic Oncology 17, no. 3 (March 2022): 362–387.
W. D. Travis, S. Dacic, I. Wistuba, et al., “IASLC Multidisciplinary Recommendations for Pathologic Assessment of Lung Cancer Resection Specimens After Neoadjuvant Therapy,” Journal of Thoracic Oncology 15, no. 5 (May 2020): 709–740.
H. Borghaei, L. Paz‐Ares, L. Horn, et al., “Nivolumab Versus Docetaxel in Advanced Nonsquamous Non‐Small‐Cell Lung Cancer,” New England Journal of Medicine 373, no. 17 (October 2015): 1627–1639.
H. Deng, J. Liu, X. Cai, et al., “Radical Minimally Invasive Surgery After Immuno‐Chemotherapy in Initially‐Unresectable Stage IIIB Non‐Small Cell Lung Cancer,” Annals of Surgery 275, no. 3 (March 2022): e600–e602.
B. Zhang, Q. Xiao, H. Xiao, et al, “Perioperative Outcomes of Video‐Assisted Thoracoscopic Surgery Versus Open Thoracotomy After Neoadjuvant Chemoimmunotherapy in Resectable NSCLC,” Frontiers in Oncology 12 (May 2022): 858189.
C. A. Shu, J. F. Gainor, M. M. Awad, et al., “Neoadjuvant Atezolizumab and Chemotherapy in Patients With Resectable Non‐Small‐Cell Lung Cancer: An Open‐Label, Multicentre, Single‐Arm, Phase 2 Trial,” Lancet Oncology 21, no. 6 (June 2020): 786–795.
A. Romero Román, J. L. Campo‐Cañaveral de la cruz, I. Macía, et al., “Outcomes of Surgical Resection After Neoadjuvant Chemoimmunotherapy in Locally Advanced Stage IIIA Non‐Small‐Cell Lung Cancer,” European Journal of Cardio‐Thoracic Surgery 60, no. 1 (July 2021): 81–88.
K. M. W. Pisters, E. Vallières, J. J. Crowley, et al., “Surgery With or Without Preoperative Paclitaxel and Carboplatin in Early‐Stage Non‐Small‐Cell Lung Cancer: Southwest Oncology Group Trial S9900, an Intergroup, Randomized, Phase III Trial,” Journal of Clinical Oncology 28, no. 11 (April 2010): 1843–1849.
M. Provencio, E. Nadal, J. L. González‐Larriba, et al., “Perioperative Nivolumab and Chemotherapy in Stage III Non‐Small‐Cell Lung Cancer,” New England Journal of Medicine 389 (June 2023): 504–513.
J. V. Heymach, T. Mitsudomi, D. Harpole, et al., “Design and Rationale for a Phase III, Double‐Blind, Placebo‐Controlled Study of Neoadjuvant Durvalumab+Chemotherapy Followed by Adjuvant Durvalumab for the Treatment of Patients With Resectable Stages II and III Non‐Small‐Cell Lung Cancer: The AEGEAN Trial,” Clinical lung cancer 23, no. 3 (May 2022): 247.
H. West, M. McCleod, M. Hussein, et al., “Atezolizumab in Combination With Carboplatin Plus Nab‐Paclitaxel Chemotherapy Compared With Chemotherapy Alone as First‐Line Treatment for Metastatic Non‐Squamous Non‐Small‐Cell Lung Cancer (IMpower130): A Multicentre, Randomised, Open‐Label, Phase 3 Trial,” Lancet Oncology 20, no. 7 (July 2019): 924–937.
W. D. Travis, S. Dacic, I. Wistuba, et al., “IASLC Multidisciplinary Recommendations for Pathologic Assessment of Lung Cancer Resection Specimens After Neoadjuvant Therapy,” Journal of Thoracic Oncology 15, no. 5 (May 2020): 709–740.