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

Abstract

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.

Hybrid video-assisted thoracoscopic sleeve lobectomy: an elegant minimally invasive technique for locally advanced non-small cell lung cancer

“…Although there are more limited reports of sleeve resection following neoadjuvant chemo-immunotherapy, a few studies have demonstrated that it is feasible yet technically challenging. One study reported a 30% rate of conversion from VATS to a hybrid approach which may be similar to that described in this study (13), while another group was more successful in using a single port VATS approach with only one of eleven patients requiring thoracotomy (14). Given this evidence, for patients requiring sleeve resections with the potential for additional technical challenges due to neoadjuvant chemoimmunotherapy, it is reasonable to consider evaluating the anatomy first with thoracoscopy before determining whether a VATS, hybrid, or open thoracotomy approach would be safest.…”

Efficacy and safety of neoadjuvant immunotherapy protocols and cycles for non-small cell lung cancer: a systematic review and meta-analysis

“…TRAEs were graded using the Common Terminology Criteria for Adverse Events (CTCAE), with TRAEs graded ≥3 being considered serious adverse events (SAEs). Eighteen studies have assessed TRAEs ( 5 , 6 , 8 – 10 , 13 – 16 , 18 – 21 , 23 , 28 , 30 , 30 , 34 , 35 , 40 , 43 , 47 , 48 ), and their incidence ranges from 17–100%. The pooled ES was 0.70 (95% CI 0.56–0.81; I²=96.02%) ( Figure 3D ).…”

“…The pooled ES was 0.70 (95% CI 0.56–0.81; I²=96.02%) ( Figure 3D ). Twenty-five studies have evaluated SAEs ( 5 , 6 , 8 – 16 , 18 – 21 , 25 – 28 , 30 , 31 , 35 – 37 , 39 , 40 , 42 , 45 – 48 ), such as myelosuppression, gastrointestinal reactions, and immune-related target organ or tissue injury. The pooled ES was 0.17 (95% CI 0.10–0.25; I²=93.35%) ( Figure 3E ).…”

Neoadjuvant immunotherapy for advanced, resectable non–small cell lung cancer: A systematic review and meta‐analysis

“…There was high interrater agreement in terms of study selection (κ = 0.979; p = .021). Table 1 displays pertinent details of each study 13–78 ; patients most commonly had stage III disease and received two to four cycles of various ICIs.…”