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Salvage surgery following downstaging of advanced non-small cell lung cancer by targeted therapy
Kuo Li1, Xiaonian Cao2, Bo Ai2
1Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Background:
Advanced non-small cell lung cancer (NSCLC) accounts for a high proportion of lung cancer cases. Targeted therapy improve the survival in these patients, but acquired drug resistance will inevitably occur. If tumor downstaging is achieved after targeted therapy, could surgical resection before drug resistance improve clinical benefits for patients with advanced NSCLC? Here, we conducted a clinical trial showing that for patients with advanced driver gene mutant NSCLC who did not progress after targeted therapy, salvage surgery (SS) could improve progression-free survival (PFS). Herein, we retrospectively reviewed our former clinical trial and thoracic cancer database in our medical institutions.
Methods:
We identified patients with advanced driver gene mutant NSCLC treated with targeted therapy plus SS or targeted therapy alone in our former clinical trial and our thoracic cancer database from July 2016 to July 2019. PFS was compared between the targeted therapy plus SS group and the targeted therapy only group using the log-rank test.
Results:
We identified 73 patients with driver gene mutant NSCLC who were treated with targeted therapy and 18 treated with targeted therapy plus SS.Among the 18 patients treated with targeted therapy plus SS, there were no obvious perioperative complications and deaths. Targeted therapy followed by SS resulted in a significantly longer PFS compared with targeted therapy alone (23.4 months VS 12.9 months, p = 0.0004).
Conclusions:
Salvage surgery after tumor downstaging is a promising therapeutic strategy for some patients with advanced (stage IIIB-IV) NSCLC and may offer a new therapeutic option for multidisciplinary comprehensive treatment of lung cancer.
Insights
Salvage surgery (SS) combined with targeted therapy significantly improves progression-free survival (PFS) in advanced non-small cell lung cancer (NSCLC) patients. This approach offers a promising option for managing drug resistance and improving outcomes in NSCLC.
Area of Science:
- Oncology
- Thoracic Surgery
- Genetics
Background:
- Advanced non-small cell lung cancer (NSCLC) presents significant treatment challenges, often involving targeted therapies.
- Acquired drug resistance is a major limitation in targeted therapy for NSCLC.
- Tumor downstaging after targeted therapy raises questions about the role of subsequent surgical intervention.
Purpose of the Study:
- To evaluate the efficacy of salvage surgery (SS) in improving progression-free survival (PFS) for advanced driver gene-mutant NSCLC patients.
- To determine if surgical resection after targeted therapy, before drug resistance, enhances clinical benefits.
- To explore SS as a therapeutic option within multidisciplinary care for advanced NSCLC.
Main Methods:
- Retrospective review of a clinical trial and institutional thoracic cancer database (July 2016 - July 2019).
- Inclusion of patients with advanced driver gene-mutant NSCLC treated with targeted therapy plus SS or targeted therapy alone.
- Comparison of PFS between the two groups using the log-rank test.
Main Results:
- 18 patients received targeted therapy followed by SS, with no significant perioperative complications.
- 73 patients received targeted therapy alone.
- Targeted therapy plus SS resulted in significantly longer PFS (23.4 months) compared to targeted therapy alone (12.9 months, p=0.0004).
Conclusions:
- Salvage surgery following tumor downstaging is a viable and promising strategy for select advanced NSCLC patients.
- This approach can improve PFS in patients with driver gene-mutant NSCLC.
- SS offers a valuable addition to the multidisciplinary treatment of lung cancer.
