[Operability and Pathological Response of Non-Small Cell Lung Cancer (NSCLC) after Neoadjuvant Therapy with Immune
E Lücke1, C Ganzert1, S Föllner1
1Klinik für Pneumologie, Otto-von-Guericke-Universität Magdeburg, Magdeburg.
Pneumologie (Stuttgart, Germany)
|August 22, 2020
Summary
Neoadjuvant immune checkpoint inhibition (ICI) in advanced non-small cell lung cancer (NSCLC) is well-tolerated and does not impede surgery. This approach can lead to complete tumor remission in selected patients, offering promising outcomes for those with a complete pathological response.
Area of Science:
- Oncology
- Immunotherapy
- Thoracic Surgery
Background:
- Immune checkpoint inhibition (ICI) targeting PD1/PD-L1 pathways shows efficacy in advanced non-small cell lung cancer (NSCLC).
- Limited data exists on neoadjuvant ICI for resectable (UICC stage III) or oligometastatic (UICC stage IVa) NSCLC.
Purpose of the Study:
- To evaluate the safety and efficacy of neoadjuvant ICI in patients with resectable or oligometastatic NSCLC.
- To assess the impact of neoadjuvant ICI on surgical procedures and oncological outcomes.
Main Methods:
- Patients with advanced or oligometastatic NSCLC and PD-L1 expression >50% received neoadjuvant ICI (pembrolizumab or atezolizumab).
- Thoracic surgical resection was performed approximately four weeks after ICI initiation.
- Comprehensive staging, tolerability, radiological and histopathological tumor response, and surgical outcomes were analyzed.
Main Results:
- Four patients (adenocarcinoma and squamous cell carcinoma) received neoadjuvant ICI without complications; surgery was not delayed.
- Partial response (PR) was observed in three patients, and stable disease (SD) in one, per iRECIST criteria.
- Complete pathological response (CPR) was achieved in two patients, with one remaining relapse-free at 12-24 months follow-up. Two patients with partial pathological response (PPR) developed distant metastasis or local recurrence.
Conclusions:
- Neoadjuvant ICI is well-tolerated and feasible in selected NSCLC patients, not negatively impacting surgical procedures.
- Complete pathological response (CPR) after neoadjuvant ICI correlates with promising oncological outcomes.
- Partial pathological response (PPR) indicates a limited prognosis, necessitating further investigation.
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