Different pathologic responses to neoadjuvant anti-PD-1 in primary squamous lung cancer and regional lymph nodes
1Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Abstract:
Neoadjuvant immunotherapy provides a unique opportunity for understanding therapeutic responses. We analyzed pathologic responses in surgical specimens obtained from 31 squamous non-small cell lung cancer (NSCLC) patients receiving neoadjuvant anti-PD-1 treatment. Fifteen (48.4%) patients achieved pathologic complete response (pCR) or major pathologic response (MPR). Among them, seven (46.7%) were assessed as radiological partial response and eight (53.3%) as stable disease. Among 20 patients with pathologically identified tumor beds in lymph nodes (LNs), 10 and six patients achieved pCR/MPR in primary tumors and paired LNs, respectively. pCR was achieved in 6/19 N1 nodes and 1/7 N2 nodes. Residual viable tumor (RVT) cells in 8/9 MPR specimens had 100% immune-activated phenotype, while a median of 80% of RVT cells in pathologic nonresponse specimens presented immune-excluded/desert phenotype. These findings demonstrated that assessment of pathologic responses in both primary tumor and LNs may be important as a surrogate for assessing neoadjuvant immunotherapeutic efficacy.
Insights
Neoadjuvant anti-PD-1 therapy shows promise in treating non-small cell lung cancer (NSCLC). Pathologic response assessment in primary tumors and lymph nodes can predict immunotherapy efficacy.
Area of Science:
- Oncology
- Immunology
- Thoracic Surgery
Background:
- Neoadjuvant immunotherapy offers a window to study treatment responses in cancer.
- Understanding pathologic responses is crucial for evaluating neoadjuvant immunotherapeutic efficacy.
Purpose of the Study:
- To analyze pathologic responses in surgical specimens from squamous non-small cell lung cancer (NSCLC) patients treated with neoadjuvant anti-PD-1 therapy.
- To correlate pathologic responses with radiological assessments and immune phenotypes of residual viable tumor (RVT) cells.
Main Methods:
- Surgical specimens from 31 NSCLC patients receiving neoadjuvant anti-PD-1 were analyzed.
- Pathologic complete response (pCR) and major pathologic response (MPR) were assessed.
- Tumor immune phenotypes in residual viable tumor cells were evaluated.
Main Results:
- 48.4% of patients achieved pCR or MPR.
- Radiological partial response was observed in 46.7% of responders.
- Residual viable tumor cells in MPR specimens showed immune-activated phenotypes, while non-responders had immune-excluded/desert phenotypes.
Conclusions:
- Pathologic response assessment in both primary tumors and lymph nodes is vital for evaluating neoadjuvant immunotherapy.
- Immune phenotypes of residual viable tumor cells correlate with treatment response.
- These findings may guide the assessment of neoadjuvant immunotherapeutic efficacy in NSCLC.
