Lung Cancer Resection after Immunochemotherapy Versus Chemotherapy in Oligometastatic Nonsmall Cell Lung Cancer

Abstract

Background Neoadjuvant immunochemotherapy is currently being tested in pivotal trials for stage I-III NSCLC. The impact of immunochemotherapy in patients with oligometastastic disease remains undefined. This study aimed to compare the outcomes of radical treatment after the neoadjuvant course of immunochemotherapy versus chemotherapy. Methods We retrospectively analyzed patients with oligometastastic disease who were treated with immunochemotherapy or chemotherapy combined with local ablation of metastases and radical primary tumor resection between 2017 and 2021. Group A included eight patients with immunochemotherapy; Group B included seven patients with chemotherapy. Descriptive statistical analysis included the characteristics of the patients, tumors, and outcomes. Results There was no difference in postoperative morbidity rates between the groups (p=0.626). The 30-day mortality in both groups was 0%. The median overall survival for Group A was not reached, with a median follow-up time of 25 (range:13-35) months; the median overall survival for Group B was 26 (range:5-53) months. In Group A, all patients remained alive; in contrast, in Group B, four patients died (p=0.026). There was no local thoracic recurrence in either group. In Group B, recurrent disease was identified significantly more often (12.5% vs. 85.75%;p=0.009). The rates of complete and major pathologic response were 37.5% and 0% in Group A and 42.85% and 14.25% in Group B, respectively. Conclusion Despite the small patient number and short-term results, the progression-free and overall survival in patients with oligometastastic disease after local therapy for metastases and primary tumor resection following neoadjuvant course of immunochemotherapy might be promising compared to chemotherapy.

Oligo-Metastatic Cancers: Putative Biomarkers, Emerging Challenges and New Perspectives

“…Unfortunately, while DLTs, particularly SRT, are widely used in clinical practice to manage OMD, there is limited evidence to support their use. A review of scientific literature from PubMed in the past year (when a peak of publications is registered) reveals a high number of heterogeneous, retrospective, and small-scale clinical studies conducted in real-world settings [ 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 ]. While these studies are important, their results cannot formally change the standard of therapy.…”

“…While these studies are important, their results cannot formally change the standard of therapy. The evidence ranges from case reports and retrospective series [ 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 ] to phase III randomized trials [ 69 ] such as the SINDAS trial. This trial showed that adding SRT to TKIs significantly improves survival in 133 EGFR-mutated NSCLC OMD patients (median OS TKI plus SRT: 25.5 months vs. 17.4 months in TKI monotherapy).…”

“…The median survivals achieved in these studies with SRT are higher than those reported in the poly-metastatic setting, 30.8 and 53.4 months, respectively, confirming that OMD has a good prognosis. However, examples of systemic approaches have also been pursued and published in the past year in OMD, including immuno-plus chemotherapy [ 61 , 62 ] and immune therapy plus SRT [ 66 ]. These studies are retrospective, heterogeneous (patients received different treatments before and/or after the therapeutic approach for OMD), and lacking in comparison with a “control” arm.…”

Prognostic analysis of the plasma fibrinogen combined with neutrophil‐to‐lymphocyte ratio in patients with non–small cell lung cancer after radical resection

“…The histological types of lung cancer include small cell lung cancer (SCLC) and non–small cell lung cancer (NSCLC), of which NSCLC accounts for 80% to 85% 3,4 . Surgery is the main treatment for resectable NSCLC, but single surgery is not sufficient for most lung cancer patients and requires a combination of adjuvant treatment 5,6 . Therefore, the question of identifying high‐risk patients with postoperative recurrence and metastasis in advance and providing appropriate clinical intervention is a hot topic in academic research.…”

“… 3 , 4 Surgery is the main treatment for resectable NSCLC, but single surgery is not sufficient for most lung cancer patients and requires a combination of adjuvant treatment. 5 , 6 Therefore, the question of identifying high‐risk patients with postoperative recurrence and metastasis in advance and providing appropriate clinical intervention is a hot topic in academic research. Tumor, node, and metastasis (TNM) stage is the most commonly used prognostic indicator regarding lung cancer in clinical practice, but patients with the same TNM stage do not have the same prognosis.…”