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Exploring perioperative treatment for non-small cell lung cancer patients harboring EGFR mutation: a real-world
Yu Zhou1, Zihan Wei2,3, Min Li4,5,6,7
1The Second Department of Thoracic Oncology, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, China.
Background:
For patients with resectable epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC), the optimal neoadjuvant regimen remains undefined. In this multicenter retrospective cohort study, we explored the efficacy and safety of immunochemotherapy, tyrosine kinase inhibitors (TKIs), and chemotherapy as perioperative treatments for patients with resectable NSCLC harboring EGFR mutations.
Methods:
Patients with untreated stage IIA-IIIB NSCLC and EGFR mutations were enrolled in the study. Neoadjuvant treatment comprised immunotherapy combined with chemotherapy, chemotherapy or TKI followed by surgery and optional adjuvant treatment. The primary endpoint was pathological response, including the pathological complete response (pCR) rate and major pathological response (MPR). The secondary endpoints included event-free survival (EFS), objective response rate (ORR), lymph node downgrade rate, and safety.
Results:
Between January 13, 2020, and September 1, 2023, of 64 patients screened, 41 patients from seven centers were included in the final efficacy analysis. The ORR of the immunochemotherapy group, the TKI group, and the chemotherapy group was 63.0% [95% confidence interval (CI): 42.4-80.6%], 41.7% (95% CI: 15.2-72.3%), and 100% (95% CI: 15.8-100%), respectively. A total of 40 patients (97.5%) underwent definitive surgery, and 55.9% of the patients achieved lymph node downgrade. Among all 40 patients receiving definitive surgery, 10 patients achieved MPR, and the MPR rate was 25.0% (95% CI: 12.7-41.2%). The pCR rate was 10.0% (95% CI: 2.8-23.7%). For the immunochemotherapy group, the MPR rate was 30.8%, and for the TKI group, the MPR rate was 8.3% (P=0.08). The pCR rates of the immunochemotherapy group and the TKI group were 15.4% and 0%, respectively (P=0.18). With a follow-up of 24.0 months, the median EFS was not reached, and the 12-month and 24-month EFS rates were 94.2% and 75.8%, respectively. Treatment-related adverse events were manageable.
Conclusions:
The combination of immunotherapy and chemotherapy as neoadjuvant treatment demonstrated a promising pathological response among patients with EGFR-mutant NSCLC.
Insights
Neoadjuvant immunochemotherapy shows promise for resectable epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC). This study found it to be a safe and effective perioperative treatment option, offering a favorable pathological response.
Area of Science:
- Oncology
- Thoracic Surgery
- Medical Oncology
Background:
- Optimal neoadjuvant regimens for resectable EGFR-mutant non-small cell lung cancer (NSCLC) are not well-defined.
- Perioperative treatments including immunochemotherapy, tyrosine kinase inhibitors (TKIs), and chemotherapy are being explored for these patients.
Purpose of the Study:
- To evaluate the efficacy and safety of neoadjuvant immunochemotherapy, TKIs, and chemotherapy in patients with resectable EGFR-mutant NSCLC.
- To compare pathological response rates and survival outcomes across different neoadjuvant treatment groups.
Main Methods:
- Multicenter retrospective cohort study including patients with untreated stage IIA-IIIB NSCLC and EGFR mutations.
- Neoadjuvant treatment options included immunotherapy plus chemotherapy, chemotherapy alone, or TKI therapy, followed by surgery.
- Primary endpoints were pathological complete response (pCR) and major pathological response (MPR); secondary endpoints included event-free survival (EFS) and safety.
Main Results:
- Immunochemotherapy demonstrated a higher objective response rate (ORR) (63.0%) compared to TKIs (41.7%).
- The major pathological response (MPR) rate was 30.8% for immunochemotherapy versus 8.3% for TKIs, with a pCR rate of 15.4% for immunochemotherapy.
- Lymph node downgrade was achieved in 55.9% of patients, and 12-month EFS was 94.2% with manageable adverse events.
Conclusions:
- Neoadjuvant immunochemotherapy presents a promising option for achieving favorable pathological responses in patients with resectable EGFR-mutant NSCLC.
- The observed safety and efficacy suggest immunochemotherapy warrants further investigation as a perioperative treatment strategy.
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