Current Evidence of the Efficacy and Safety of Neoadjuvant EGFR-TKIs for Patients With Non-small Cell Lung Cancer

Shi, Xiaoshun; Dong, Xiaoying; Zhai, Jianxue; Liu, Xiguang; Lu, Da-Yong; Ni, Zhen; Wu, Hua; Cai, Kaican

doi:10.3389/fonc.2021.608608

Cited by 5 publications

(3 citation statements)

References 17 publications

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“…The ORR of neoadjuvant EGFR- TKI in the EGFR-sensitive mutation population is 48% and early stage NSCLC may reduce the ORR of neoadjuvant EGFR-TKIs ( 23 ), and the MPR of neoadjuvant Osimertinib was 15% ( 5 ). However the evidence for neoadjuvant targeted therapy especially in these subgroups of EGFR mutation status, PD-L1 expression is still not sufficient.…”

Section: Discussionmentioning

confidence: 99%

EGFR mutations and high PD-L1 expression of lung squamous cell carcinoma patients achieving pCR following neoadjuvant immuno-chemotherapy: Case report

Shi²,

Fu³

et al. 2022

Front. Oncol.

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The treatment of lung cancer has fully entered the era of immunotherapy, which has significantly elevated the survival rate of patients with advanced non-small cell lung cancer (NSCLC), thus shedding light on resectable NSCLC. Previous clinical trial data suggested that neoadjuvant immuno-chemotherapy obtained a significant objective response rate (ORR) and disease control rate (DCR). Here, a case that achieved an excellent outcome following neoadjuvant immuno-chemotherapy was reported. The patient admitted to our hospital was 58 years old, female, with a rare case of stage IB lung squamous cell carcinoma (LUSC) harboring both epidermal growth factor receptor (EGFR) p.L858R mutations and high expression of programmed death ligand-1 (PD-L1) (tumor proportion score (TPS)=80%). Her tumor substantially shrunk following two cycles of neoadjuvant immuno-chemotherapy. The patient successively received single-port right upper thoracoscopic lobectomy + mediastinal lymph node dissection, which attained pathologic complete response (pCR). Additionally, the patient had grade 2 myelosuppression during the two cycles, which was treated with polyethylene glycol recombinant human granulocyte colony-stimulating factor (rhG-CSF). The patient was discharged uneventfully without any procedure-related complications. Two courses of adjuvant immuno-chemotherapy were administered postoperatively, leaving the patient in good physical condition at the 5-month follow-up visit. This case provided evidence for the feasibility and effectiveness of neoadjuvant immuno-chemotherapy in treating early-stage LUSC with EGFR mutations and high expression of PD-L1. However, randomized and multi-center controlled trials are required to validate the findings.

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Section: Discussionmentioning

confidence: 99%

EGFR mutations and high PD-L1 expression of lung squamous cell carcinoma patients achieving pCR following neoadjuvant immuno-chemotherapy: Case report

Shi²,

Fu³

et al. 2022

Front. Oncol.

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“…Sang-Won Um: If the tumor harbors sensitizing EGFR mutations or ALK rearrangements, targeted therapy seems to be a good option. However, previous studies about neoadjuvant EGFR-TKIs or ALK-TKIs were usually small sample sizes and single-arm studies (33,34). More data are needed to elucidate the exact role of EGFR-TKIs or ALK-TKIs in the neoadjuvant setting.…”

Section: What Kind Of Induction Therapy Should We Choose For Such An ...mentioning

confidence: 99%

Osimertinib as induction therapy for oligometastatic non-small cell lung cancer with EGFR mutation: a case report

Wu¹,

Ning²,

Li³

et al. 2022

Transl Lung Cancer Res

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Background: The role of surgery in combined modality therapy for selected stage IV oligometastatic (OM) non-small cell lung cancer (NSCLC) is still controversial. Tyrosine kinase inhibitors (TKIs) targeting epidermal growth factor receptor (EGFR) significantly improved the survival in adjuvant therapy in metastatic NSCLC but has rare evidence in inductive setting. This is the first case report about uniportal video-assisted thoracic surgery after induction therapy of TKI for OM-NSCLC. Case Description: A 50-year-old Chinese woman presented to hospital with headache and blurred vision and was diagnosed with an intracranial tumor. The craniotomy confirmed the metastasis from primary lung cancer. Positron emission tomography/computed tomography (PET/CT) showed the mass located in the left upper lobe and left hilar lymph node involvement. Next-generation sequencing found an EGFR mutation (exon 21 p.L858R missense), and osimertinib, a third-generation TKI, was used 80 mg per day as the induction therapy due to the EGFR mutation detected from the metastatic tumor. A favorable treatment response was observed of the lung tumor with lymph node regression, followed by uniportal thoracoscopic left upper lobectomy and systematic lymphadenectomy. The postoperative pathology evaluated both the lung lesion and lymph nodes and confirmed the OM status of this patient. No complications were observed and postoperative osimertinib 80 mg per day continued. Conclusions: Our case suggests that the role of surgery should be appropriately reevaluated for EGFRmutated OM-NSCLC with the emerging development of EGFR-TKI.

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“…Savolitinib is an oral, potent and highly selective type Ib MET inhibitor that has yielded promising activity and acceptable safety profile in patients with pulmonary sarcomatoid carcinoma and other NSCLCs harboring METex14m (2). Recently, a growing body of research has shown the feasibility of the neoadjuvant targeted therapy for early-stage resectable NSCLC patients with anaplastic lymphoma kinase (ALK) fusion gene, epidermal growth factor receptor (EGFR) mutations, RET rearrangements and ROS proto-oncogene 1 (ROS1) rearrangements (3)(4)(5)(6). The fact suggests that the untargeted patients with METex14m had a shorter disease-free survival (DFS) (7).…”

Section: Introductionmentioning

confidence: 99%

Neoadjuvant Savolitinib targeted therapy stage IIIA-N2 primary lung adenocarcinoma harboring MET Exon 14 skipping mutation: A case report

Feng

Xia

et al. 2022

Front. Oncol.

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MET exon 14 skipping mutation (METex14m) is rare and occurs in approximately 1-4% of all non-small cell lung cancer (NSCLC) patients and approximately 2.8% of resected stage I-III NSCLC patients. Savolitinib is an oral, potent and highly selective type Ib MET inhibitor, which has been shown to be promising activity and acceptable safety profile in patients with advanced NSCLC harboring METex14m. Most recently, many studies have been probing into the feasibility and efficacy of target therapy for perioperative application in NSCLC. Interestingly, there are very few recorded cases of such treatments. Here, we presented that systemic treatment with the MET inhibitor savolitinib before surgery could provide the potential to prolong overall survival (OS) of patients with locally advanced potentially resectable NSCLC. A 49-year-old woman was diagnosed with stage IIIA (T2bN2M0) primary lung adenocarcinoma exhibiting a METex14m by real-time quantitative polymerase chain reaction (RT-qPCR). Given that the tumor load and the size of lymph nodes experienced a significant downstaging after the neoadjuvant treatment of savolitinib with 600mg once a day for 5 weeks, left lower lobectomy and systemic lymphadenectomy were successfully performed. The pathological response was 50% and the final postoperative pathological staging was pT1cN0M0, IA3 (AJCC, 8th edition). The case provides empirical basis for the neoadjuvant treatment with savolitinib in METex14m-positive locally advanced primary lung adenocarcinoma, which will offer some innovative insights and clinical evidence for more effective clinical treatment of neoadjuvant targeted therapy for METex14m-positive NSCLC.

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Current Evidence of the Efficacy and Safety of Neoadjuvant EGFR-TKIs for Patients With Non-small Cell Lung Cancer

Cited by 5 publications

References 17 publications

EGFR mutations and high PD-L1 expression of lung squamous cell carcinoma patients achieving pCR following neoadjuvant immuno-chemotherapy: Case report

EGFR mutations and high PD-L1 expression of lung squamous cell carcinoma patients achieving pCR following neoadjuvant immuno-chemotherapy: Case report

Osimertinib as induction therapy for oligometastatic non-small cell lung cancer with EGFR mutation: a case report

Neoadjuvant Savolitinib targeted therapy stage IIIA-N2 primary lung adenocarcinoma harboring MET Exon 14 skipping mutation: A case report

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