Induction treatment in patients with stage III non-small cell lung cancer

Palmero, Ramón; Navarro-Martín, Arturo; Nadal, Ernest

doi:10.21037/tlcr-20-420

Cited by 9 publications

(6 citation statements)

References 51 publications

(41 reference statements)

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“…Jia et al reported the e cacy and safety of neoadjuvant immunotherapy. Compared with the results of neoadjuvant chemoimmunotherapy in our meta-analysis, neoadjuvant immunotherapy has less rate of MPR (37%) and pCR (14%), a similar surgical resection rate (88%), a higher incidence of surgical complications (29%), and surgical delay rate (3%), but good tolerance of toxicity (TRAE16%) [26], this similar conclusion was also suggested in Palmero et al [27]. Results of CheckMate 816, a phase III trial, reported that the pCR was 23% and event-free survival was 31.6% in stage IIIA NSCLC, moreover, the greater bene t was seen in stage IIIA than in those with stage IB or II patients, which strongly supported our research [28].…”

Section: Discussionsupporting

confidence: 86%

A systematic review and meta-analysis of neoadjuvant chemoimmunotherapy in stage III non-small cell lung cancer

Liu

Zhang

et al. 2022

Preprint

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Background Currently, some studies reported neoadjuvant therapy for stage IB-III lung cancer could achieve pathological downstaging and surgical resection. Stage III non-small cell lung cancer (NSCLC) is a heterogeneous disease with different subtypes, multidisciplinary teams-led management, and a poor prognosis. However, the clinical benefits of stage III NSCLC in the neoadjuvant setting are still unclear. We performed a meta-analysis of published data on neoadjuvant chemoimmunotherapy in stage III NSCLC to systematically evaluate its efficacy and safety. Methods We searched the databases to identify eligible studies of neoadjuvant chemoimmunotherapy for stage III NSCLC. The primary outcomes mainly included pathological and radiological response outcomes, the feasibility of surgery, and the safety of the regimen. The pathological and radiological response included the rate of major pathologic response (MPR), complete pathologic response (pCR), radiological response outcomes, and R0 resection; The feasibility included the rate of surgical resection, conversion to thoracotomy, surgical complications, pathological downstaging of clinical disease stage. The safety included the incidence of treatment-related adverse events (TRAEs) and severe adverse events (SAEs). R 4.1.3 software was conducted for data analysis, and p < 0.05 was considered statistically significant. Sensitivity and heterogeneity analyses were performed. Results Nine trials containing a total of 382 populations were eligible for the meta-analysis, with the pooled surgical resection rate of 90%. Owing to the large heterogeneity of the single-rate meta-analysis, the random effect model was adopted. The estimated pooled prevalence of MPR was 56% (95%CI, 0.39–0.72) and of pCR was 39% (95%CI, 0.28–0.51). The pooled rate of TRAEs was 65% (95%CI, 0.17–0.99) and SAEs was 24% (95%CI, 0.05–0.49). Compared to neoadjuvant chemotherapy or immunotherapy, neoadjuvant chemoimmunotherapy achieved more pathological and radiological relief, and has a high surgical resection rate and low risk of conversion to thoracotomy and surgical complications, with poor tolerance of toxicity but rarely developing life-threatening adverse events. Conclusion In conclusion, neoadjuvant chemoimmunotherapy is suggested to be beneficial for stage III NSCLC, which provides a promising therapeutic strategy.

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Section: Discussionsupporting

confidence: 86%

A systematic review and meta-analysis of neoadjuvant chemoimmunotherapy in stage III non-small cell lung cancer

Liu

Zhang

et al. 2022

Preprint

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show abstract

“…Jia et al reported the efficacy and safety of neoadjuvant immunotherapy. Compared with the results of neoadjuvant chemoimmunotherapy in our meta-analysis, neoadjuvant immunotherapy has less rate of MPR (37%) and pCR (14%), a similar surgical resection rate (88%), a higher incidence of surgical complications (29%), and surgical delay rate (3%), but good tolerance of toxicity (TRAE16%) [ 26 ], this similar conclusion was also suggested in Palmero et al [ 27 ]. Results of CheckMate 816, a phase III trial, reported that the pCR was 23% and event-free survival was 31.6% in stage IIIA NSCLC, moreover, the greater benefit was seen in stage IIIA than in those with stage IB or II patients, which strongly supported our research [ 28 ].…”

Section: Discussionsupporting

confidence: 86%

A systematic review and meta-analysis of neoadjuvant chemoimmunotherapy in stage III non-small cell lung cancer

Liu

Zhang

et al. 2022

BMC Pulm Med

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Background Stage III non-small cell lung cancer (NSCLC) is a heterogeneous disease with different subtypes, multidisciplinary teams-led management, and a poor prognosis. Currently, the clinical benefits of stage III NSCLC in the neoadjuvant setting are still unclear. We performed a meta-analysis of published data on neoadjuvant chemoimmunotherapy in stage III NSCLC to systematically evaluate its efficacy and safety. Methods We searched the databases to identify eligible studies of neoadjuvant chemoimmunotherapy for stage III NSCLC. The primary outcomes mainly included pathological and radiological response outcomes, the feasibility of surgery, and the safety of the regimen. The pathological and radiological response included the rate of major pathologic response (MPR), complete pathologic response (pCR), radiological response outcomes, and R0 resection; The feasibility included the rate of surgical resection, conversion to thoracotomy, surgical complications, pathological downstaging of clinical disease stage. The safety included the incidence of treatment-related adverse events (TRAEs) and severe adverse events (SAEs). R 4.1.3 software was conducted for data analysis, and p < 0.05 was considered statistically significant. Results Nine trials containing a total of 382 populations were eligible for the meta-analysis, with the pooled surgical resection rate of 90%. Owing to the large heterogeneity of the single-rate meta-analysis, the random effect model was adopted. The estimated pooled prevalence of MPR was 56% (95%CI 0.39–0.72) and of pCR was 39% (95%CI 0.28–0.51). The pooled rate of TRAEs was 65% (95%CI 0.17–0.99) and SAEs was 24% (95%CI 0.05–0.49). Conclusion Compared to neoadjuvant chemotherapy or immunotherapy, neoadjuvant chemoimmunotherapy achieved more pathological and radiological relief, and has a high surgical resection rate and low risk of conversion to thoracotomy and surgical complications, with poor tolerance of toxicity but rarely developing life-threatening adverse events. In conclusion, neoadjuvant chemoimmunotherapy is suggested to be beneficial for stage III NSCLC.

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“…Notably, two to four treatment cycles were administrated in most of the relevant phase II/III trials on neoadjuvant immunotherapy (15)(16)(17)20,21). Extended treatment cycles might result in the postponement of surgery, while a short course of treatment may not be sufficient for ICB to induce its effect.…”

Section: Introductionmentioning

confidence: 99%

Preoperative immunochemotherapy for locally advanced non-small cell lung cancer: an analysis of the clinical outcomes, optimal number of cycles, and peripheral immune markers

Deng¹,

Liang²,

Chen³

et al. 2022

Transl Lung Cancer Res

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Background: This retrospective study aimed to evaluate the real-world efficacy of neoadjuvant immunochemotherapy in locally advanced stage III non-small cell lung cancer (NSCLC), with a particular focus on analyzing the optimal treatment cycle and peripheral immune markers.Methods: Eligible patients with biopsy-confirmed stage III NSCLC who underwent neoadjuvant immunochemotherapy between January 1 st , 2018 and March 30 th , 2021 were identified, and their oncological outcomes were collected.Results: A total of 115 patients were identified, among whom 61, 51, and three cases were classified as clinical stage IIIA, IIIB, and IIIC at presentation, respectively. The objective response rate was 61.7% (71/115) after immunochemotherapy. The most frequent surgical procedure was lobectomy, performed in 91 (79.1%) cases, and all patients had microscopic-free margins. Major pathological response (MPR) was observed in 64 (55.7%) patients, among whom 44 (38.3%) achieved a complete pathological response; pathological-confirmed lymph node downstage (cN2-3 to ypN0-1) was described in 73.6% (67/91) of patients with cN2-3 diseases. The median disease-free survival (DFS) of all enrolled patients was 23.6 [95% confidence interval (CI): 15.9-31.3] months, while for patients with residual tumors of more than 10%, the median DFS was 18.1 (95% CI: 12.5-23.8) months. The post-hoc analysis showed that three [odds ratio (OR), 95% CI: 4.10, 0.79-21.32] and four (OR: 7.75, 95% CI: 1.03-58.58) cycles of neoadjuvant immunochemotherapy were prone to higher MPR rates compared to two cycles in patients that were classified as complete/partial response (CR/PR). However, adding over five cycles was not associated with a higher MPR rate (OR, 95% CI: 1.00, 0.16-6.37). The pretreatment lymphocyte count level (1.89±0.68 vs. 1.59±0.63, P=0.019) and monocyte count level (0.71±0.32 vs. 0.59, P=0.020) were significantly higher in MPR patients compared to non-MPR patients. Conclusions:The present study confirmed a favorable real-world tumor downstage efficacy of neoadjuvant immunochemotherapy in locally advanced NSCLC. Even though CR/PR was achieved, it is still beneficial when extended into 3-4 cycles of neoadjuvant immunochemotherapy.

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Induction treatment in patients with stage III non-small cell lung cancer

Cited by 9 publications

References 51 publications

A systematic review and meta-analysis of neoadjuvant chemoimmunotherapy in stage III non-small cell lung cancer

A systematic review and meta-analysis of neoadjuvant chemoimmunotherapy in stage III non-small cell lung cancer

A systematic review and meta-analysis of neoadjuvant chemoimmunotherapy in stage III non-small cell lung cancer

Preoperative immunochemotherapy for locally advanced non-small cell lung cancer: an analysis of the clinical outcomes, optimal number of cycles, and peripheral immune markers

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