Analysis of key clinical features for achieving complete remission in stage III and IV non-small cell lung cancer patients

Aoki, Takuya; Akiba, Takeshi; Nishiyama, Jun; Tajiri, Sakurako; Hayama, Naoki; Takahashi, Genki; Tanaka, Jun; Sato, Mariko; Takiguchi, Hiroto; Tomomatsu, Hiromi; Tomomatsu, Katsuyoshi; Takihara, Takahisa; Niimi, Kyoko; Oguma, Tsuyoshi; Kohno, Mitsutomo; Masuda, Ryosuke; Urano, Tetsuya; Kajiwara, Hiroshi; Nakamura, Naoya; Kunieda, Etsuo; Matsumae, Mitsunori; Iwazaki, Masayuki; Asano, Koichiro

doi:10.1186/s12931-019-1235-3

Cited by 7 publications

(7 citation statements)

References 55 publications

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“…Only Stage IV (not III) was associated with reduced odds of achieving CR (AOR = 0.34). These findings confirm a well-established relationship between advanced NSCLC stage and poorer survival [19][20].…”

Section: Variablessupporting

confidence: 87%

Does the Combined Use of Aspirin and Immunotherapy Result in Better Outcomes in Non-Small Cell Lung Cancer Than Immunotherapy Alone?

Aiad¹,

Tahir²,

Fresco³

et al. 2022

Cureus

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Introduction: Immunotherapy works by stimulating the immune system against cancer cells. Resistance to immunotherapy represents a significant challenge in the field of medical oncology. The mechanisms by which cancer cells evade immunotherapy are not well understood. Prior research suggested overexpression of prostaglandin E-2 (PGE-2) by cancer cells, which bind to EP-2 and EP-4 receptors on the tumor-specific cytotoxic T-lymphocytes (CTLs) and suppress their anticancer role. This immunosuppressive effect is involved in evading the programmed cell death-1 (PD-1)/programmed death-ligand 1 (PD-L1) blockade of immunotherapy, which fuels cancer cell growth and recurrence. Studies found that combining PGE-2 blockade and a PD-1 signaling inhibitor helped promote the anticancer immunity cells. If confirmed in a clinical setting, the above in vitro findings could be of great clinical significance.Methods: Given that aspirin (ASA) blocks PGE-2 production, this work aimed to evaluate whether ASA use with immunotherapy results in better outcomes than immunotherapy alone. We performed a retrospective chart review of 500 non-small cell lung cancer (NSCLC) patients aged 21 years or older treated with PD-1 and/or PD-L1 directed immunotherapy at St. Luke's University Health Network between July 2015 and July 2021. Relevant patient, disease, and treatment-related variables were collected, including ASA use (≥ 81 mg daily) and the type of immunotherapy. Bivariate analyses were conducted to determine which variables to include in a multivariable model.The four primary outcomes included survival at 18-months, both after diagnosis and starting immunotherapy, achieving complete remission (CR), and having a progressive disease (PD), as defined by RECIST (Response Evaluation Criteria in Solid Tumors) criteria. Secondary outcomes included therapyrelated toxicities and complications in the different treatment groups.Results: After bivariate analysis, no statistical significance was found for a difference in 18-month survival between ASA and non-ASA groups (50.3% vs 49.7%, p-value = 0.79). ASA with PD-L1 inhibitor showed a trend towards a higher likelihood of achieving CR [adjusted odds ratio (AOR) 1.85] with a p-value close to statistical significance (0.06). However, ASA with PD-L1 showed high statistical significance as an independent variable associated with a decreased likelihood of having PD (AOR 0.44, p < 0.001). These findings suggest that NSCLC patients receiving PD-L1 inhibitors could benefit more from daily ASA than patients treated with PD-1 inhibitors. Our study emphasizes using the Eastern Cooperative Oncology Group (ECOG) scoring of the performance status (PS) in NSCLC patients. Poorer PSwas associated with lower survival, decreased likelihood of CR, and more PD. Other variables associated with worse outcomes were advanced cancer stage at diagnosis and male gender. Low-PD-L1 expression in NSCLC was associated with an increased likelihood of survival; this could be of clinical significance, especially with previous studies su...

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Section: Variablessupporting

confidence: 87%

Does the Combined Use of Aspirin and Immunotherapy Result in Better Outcomes in Non-Small Cell Lung Cancer Than Immunotherapy Alone?

Aiad¹,

Tahir²,

Fresco³

et al. 2022

Cureus

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“…Recently, Immunotherapy has altered the treatment landscape of late stage NSCLC patients and brought a new perspective to the application of surgery in Stage III patients. Immunotherapy alone or combined with chemotherapy has been shown to improve the overall survival of unresectable NSCLC patients ( 18 ). Therefore, as immunotherapy is being used in advanced NSCLC patients, neoadjuvant Immuno-chemotherapy is being evaluated in Stage III patients.…”

Section: Discussionmentioning

confidence: 99%

Neoadjuvant Immuno-Chemotherapy: A New Perspective for Stage III NSCLC?

et al. 2022

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BackgroundStage III Non-small cell lung cancer (NSCLC) is a heterogenous disease with novel treatment options. Recently, immunotherapy has attracted a lot of attention for advanced NSCLC.ObjectiveThe objective of our study was to assess the efficacy and safety of neoadjuvant immuno-chemotherapy for resectable stage III NSCLC.MethodsWe analyzed 11 stage III primary NSCLC surgical cases who had undergone standard lobectomy or bronchial sleeve resection and lymph node dissection between December 2020 and July 2021. The data analyzed included basic clinical features, serum levels of key biomarkers, clinical efficacy in the perioperative period, postoperative pathological results, postoperative complications and the incidence rates of Immune-Related Adverse Events.ResultsEleven patients were enrolled in our study with a mean age of 67.7 ± 4.8 years, and 10 patients being men with former or current smoking history. Squamous carcinoma (10/11, 91.1%) was the most common cancer type. Six patients had stage IIIa, five had stage IIIb. All patients received two or three cycles of neoadjuvant immuno-chemotherapy, with the median duration between the last treatment and surgery being 39 days (range, 32–46 days). All patients underwent R0 resection with ten patients undergoing single-port video-assisted thoracoscopic surgery. The median operative time was 170 min (range, 120–240 min). Only three (3/11, 27.3%) patients experienced mild postoperative complications and the mean hospital stay time was 6.9 days (range, 4–15 days). Nine (9/11, 81.8%) patients experienced major pathological response of which seven (7/11, 63.6%) was complete pathological response in postoperative results. The pathological stage was downgraded in 10 (10/11, 91.1%) patients, and although the incidence of Immune-Related Adverse Events was slightly higher (8/11, 72.7%), most events were grade 1–2 and did not delay surgery.ConclusionOur study demonstrated that neoadjuvant immuno-chemotherapy is feasible and relatively safe for resectable stage III primary NSCLC patients. We hope this new neoadjuvant immuno-chemotherapy model can improve overall survival and open a new era for stage III primary NSCLC patients.

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“… 2 However, Aoki et al reported that 80% of patients diagnosed with stage IV lung cancer but achieved complete remission received local radical therapy such as surgery or radiation during treatment, though this complete remission does not directly mean improving their survival. 18 This suggests that radical local therapy as a part of comprehensive multimodal treatment could benefit selected patients with stage IV lung cancer to achieve complete remission. In the present case, there was a small size of residual alive tumors in a surgical specimen of primary tumor and lymph node metastasis.…”

Section: Discussionmentioning

confidence: 99%

“…Aoki et al also reported a few similar long-term survivors without cancer treatment in patients with stage IV lung cancer. 18 Additionally, several studies reported the effectiveness of hyperthermic intrathoracic chemotherapy (HITHOC) that it can control the symptoms and prolong the survival of patients with MPE. 34 Surgery combined with HITHOC has been recently reported to be an effective surgical intervention for selected pM1a patients to prolong life expectancy.…”

Section: Discussionmentioning

confidence: 99%

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Long-Term Treatment-Free Survival After Multimodal Therapy in a Patient with Stage IV Lung Adenocarcinoma

Takaoka¹,

Terai²,

Emoto³

et al. 2022

OTT

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We report the first case of a patient with non-small cell lung cancer (NSCLC) with malignant pleural effusion (MPE) who achieved disease- and treatment-free survival for nearly 10 years. A 50-year-old man was diagnosed with NSCLC with MPE and underwent chemotherapy and salvage thoracic surgery. The patient received chemotherapy with cisplatin, pemetrexed, and bevacizumab, and a partial response was achieved. After informed consent was obtained from the patient, right middle lobectomy was performed to achieve local tumor control. Postoperative adjuvant chemotherapy with pemetrexed and bevacizumab was discontinued after almost 1 year of chemotherapy due to side effects such as diarrhea and muscle weakness. The patient has survived without recurrence of lung cancer for more than 11 years after being diagnosed and nearly 10 years after discontinuing chemotherapy.

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Analysis of key clinical features for achieving complete remission in stage III and IV non-small cell lung cancer patients

Cited by 7 publications

References 55 publications

Does the Combined Use of Aspirin and Immunotherapy Result in Better Outcomes in Non-Small Cell Lung Cancer Than Immunotherapy Alone?

Does the Combined Use of Aspirin and Immunotherapy Result in Better Outcomes in Non-Small Cell Lung Cancer Than Immunotherapy Alone?

Neoadjuvant Immuno-Chemotherapy: A New Perspective for Stage III NSCLC?

Long-Term Treatment-Free Survival After Multimodal Therapy in a Patient with Stage IV Lung Adenocarcinoma

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