1
|
Zhao ZR, Yan WP, Yu XY, Zhang JB, Fang YF, Ma K, Luo QQ, Long H, Chen KN, Jiang L. Adjuvant immunotherapy does not improve survival in non-small cell lung cancer with major/complete pathologic response after induction immunotherapy. J Thorac Cardiovasc Surg 2025; 169:1576-1584.e3. [PMID: 39617319 DOI: 10.1016/j.jtcvs.2024.11.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 10/17/2024] [Accepted: 11/15/2024] [Indexed: 01/06/2025]
Abstract
BACKGROUND In patients with resectable non-small cell lung cancer (NSCLC), immune checkpoint inhibitor (ICI)-based regimens in both neoadjuvant and perioperative settings have demonstrated a survival benefit. However, no previous study has compared the efficacy between pure neoadjuvant and perioperative approaches, especially in patients who achieve a substantial pathologic response. METHODS In this retrospective study, patients with clinical stage II-IIIB NSCLC who achieved either a major pathologic response (MPR) or pathologic complete response (pCR) after induction ICI plus chemotherapy, followed by resection, between 2019 and 2023 were identified from multicenter databases. Inverse probability of treatment weighting-adjusted Cox regression was performed to compare disease-free survival (DFS) and overall survival (OS) between patients who received ICIs postoperatively and those who did not. RESULTS One hundred thirty-six patients who achieved pCR and 72 patients who achieved MPR were enrolled. Three-quarters of them had squamous cell cancer. The inverse probability-weighted cohort represented 208 weighted patient cases (adjuvant ICI group, n = 117; control group, n = 91). The weighted DFS and OS rates did not differ between the adjuvant ICI group and the control group (3-year DFS rate: 90.2% vs 93.2%; hazard ratio [HR], 2.47; 95% confidence interval [CI], 0.74-8.22; 3-year OS rate: 89.1% vs 93.9%; HR, 2.44; 95% CI, 0.71-8.34). Adverse events during the postoperative ICI treatment were found in 19 of 120 patients (15.8%) and led to adjuvant ICI termination in 18 patients (15.0%). CONCLUSIONS Adjuvant ICI does not improve survival in NSCLC patients who achieve pCR/MPR following neoadjuvant immunochemotherapy. A de-escalation strategy could be considered, given the adverse events associated with postoperative ICI treatment.
Collapse
Affiliation(s)
- Ze-Rui Zhao
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wan-Pu Yan
- Key Laboratory of Carcinogenesis and Translational Research, Department of Thoracic Surgery I, Peking University Cancer Hospital and Institute, Beijing, China
| | - Xiang-Yang Yu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer, Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Jing-Bo Zhang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yi-Fan Fang
- Key Laboratory of Carcinogenesis and Translational Research, Department of Thoracic Surgery I, Peking University Cancer Hospital and Institute, Beijing, China
| | - Kai Ma
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer, Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Qing-Quan Luo
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hao Long
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Ke-Neng Chen
- Key Laboratory of Carcinogenesis and Translational Research, Department of Thoracic Surgery I, Peking University Cancer Hospital and Institute, Beijing, China
| | - Long Jiang
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| |
Collapse
|
2
|
Chen T, Liu F. Neoadjuvant immunotherapy in early-stage NSCLC: navigating biomarker dilemmas and special population challenges. Lung Cancer 2025; 204:108588. [PMID: 40409027 DOI: 10.1016/j.lungcan.2025.108588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2025] [Accepted: 05/17/2025] [Indexed: 05/25/2025]
Abstract
Neoadjuvant immunotherapy has shown impressive outcomes in treating non-small cell lung cancer (NSCLC) recently due to advancements in immune checkpoint inhibitors (ICIs) research. Neoadjuvant immunotherapy can lower the tumor load, raise the complete surgical (R0) resection rate, and improve clinical outcomes by alleviating the immune system repression caused by tumor cells. This review provides a comprehensive evaluation of neoadjuvant immunotherapy in NSCLC, focusing on: (1) its safety and efficacy profiles, (2) the most recent clinical trial evidence, and (3) critical unresolved challenges including predictive biomarker development, management of driver mutation-positive patients, chronic obstructive pulmonary disease (COPD) comorbidity considerations, and its application in stage III-IVA (oligometastatic) disease. Furthermore, we explore future research directions to optimize neoadjuvant immunotherapy approaches for resectable NSCLC, aiming to guide clinical practice and investigation.
Collapse
Affiliation(s)
- Tong Chen
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Fang Liu
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China.
| |
Collapse
|
3
|
Huang H, Bao P, Jin H, Li W, Shen H, Qin Z, Pan Y, Su X, Kong D. Adjuvant immunotherapy improves survival in completely resected stage IB-III NSCLC: a systematic review and meta-analysis. Front Oncol 2025; 15:1493221. [PMID: 40265009 PMCID: PMC12011596 DOI: 10.3389/fonc.2025.1493221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2024] [Accepted: 03/20/2025] [Indexed: 04/24/2025] Open
Abstract
Background The clinical benefits of postoperative chemotherapy for non-small cell lung cancer (NSCLC) have plateaued, thus highlighting the need for novel strategies. This meta-analysis evaluated the efficacy and safety of adjuvant immunotherapy in patients with completely resected NSCLC and wild-type epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK). Methods PubMed, Web of Science, Embase, and the Cochrane Library were searched up to February 12, 2025, for studies assessing adjuvant immunotherapy in NSCLC. Primary endpoints included disease-free survival (DFS), overall survival (OS), correlation between subgroup characteristics and efficacy, and safety outcomes, including treatment-related adverse events (TRAEs), severe adverse events (SAEs), and treatment discontinuation. Results Twelve articles involving 4048 patients were included. Adjuvant immunotherapy significantly improved DFS in patients with resected stage IB-III NSCLC than supportive care or placebo (hazard ratio [HR]: 0.82, 95% confidence interval [CI]: 0.72-0.93, p = 0.01; I2 = 0%, p = 0.46). However, the OS benefit was not significant (HR: 0.9, 95% CI: 0.67-1.21, p = 0.34). DFS benefit was observed in EGFR-negative (HR: 0.75, 95% CI: 0.62-0.91, I2 = 0%), EGFR status unknown (HR: 0.78, 95% CI: 0.63-0.96, I2 = 0%), programmed cell death ligand 1 (PD-L1) 1-49% (HR: 0.75, 95% CI: 0.58-0.97, I2 = 7.13%), non-squamous cell carcinoma (HR: 0.72, 95% CI: 0.61-0.84, I2 = 0%), and never-smoking (HR: 0.68, 95% CI: 0.49-0.96, I2 = 0%) subgroups. The pooled incidences of TRAEs, SAEs, and discontinuation of treatment due to toxicity were 70% (95% CI: 62%-77%), 12% (95% CI: 8%-16%), and 17% (95% CI: 15-19%), respectively. Conclusions Adjuvant immunotherapy improved DFS in patients with completely resected NSCLC, particularly those who were EGFR-negative, had PD-L1 levels of 1-49%, had non-squamous cell carcinoma, or never smoked. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO, identifier CRD42024547752.
Collapse
Affiliation(s)
- Hong Huang
- Department of Pulmonary and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China
| | | | - Hongyu Jin
- Department of Pulmonary and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Wenyang Li
- Department of Pulmonary and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Hui Shen
- Department of Pulmonary and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Zhen Qin
- Department of Pulmonary and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Ying Pan
- Department of Laboratory Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Xinming Su
- Department of Pulmonary and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Delei Kong
- Department of Pulmonary and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China
| |
Collapse
|
4
|
Prabhash K, Moor R, Göksel T, Nyaw J, Altwairgi AK, Gonzalez F, Mohamed E, Kantharaju P, Sadek F. Real-World Treatment Patterns and Associated Outcomes in Patients With Resectable Early-Stage Non-Small Cell Lung Cancer: The THASSOS International Study. Thorac Cancer 2025; 16:e70061. [PMID: 40269461 PMCID: PMC12018281 DOI: 10.1111/1759-7714.70061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2025] [Revised: 03/12/2025] [Accepted: 03/25/2025] [Indexed: 04/25/2025] Open
Abstract
BACKGROUND THASSOS-INTL (NCT04808050), a multinational, retrospective study, evaluated treatment patterns and associated outcomes in patients with early-stage non-small cell lung cancer (NSCLC) from seven countries in the Asia-Pacific and the Middle-East and Africa. METHODS Eligible adult patients (≥ 18 years) with resectable clinical stage (CS) IA-IIIB NSCLC (7th AJCC) diagnosed from 01/01/2013 to 31/12/2017 were followed until death, last recorded clinical visit, or 31/12/2020 (data cut-off). RESULTS Of 755 patients (CS I: 30.6%, CS II: 35.0%, CS III: 34.2%) with a median age of 62 [range: 56-69] years enrolled, 69.3% were male, and 75.0% were current/ex-smokers. Of 24.2% of patients tested for EGFR, 28.4% (52/183) were positive, while 23/44 patients tested (52.3%) had PD-L1 expression (≥ 1%: 16; unknown: 7). Overall, 82.9% had surgery, of whom 39.1% (245/626) had surgery alone; 21.1% received neoadjuvant therapy, 51.1% received adjuvant therapy, and 5.8% received both; 11.2% (58/519) patients received targeted therapy (adjuvant: 47 patients; neoadjuvant: 11 patients), and 4.6% (24/519) received immunotherapy (adjuvant: 22 patients; neoadjuvant: 2 patients). The 3-year survival was 77.4% with a median overall survival (mOS) of 7.5 (95% confidence interval [CI]: 6.7-NE) years, with the highest mOS recorded with adjuvant therapy (7.5 [95% CI: 7.0-NE] years). CONCLUSIONS This real-world study showed > 50% use of adjuvant therapy per guideline recommendations but poor use of neoadjuvant therapy. Biomarker testing at diagnosis was low, reflecting the study period being before targeted and immunotherapies. With recent approvals of newer (neo)adjuvant agents, a multidisciplinary approach is needed for better treatment decisions to improve the prognosis of early-stage NSCLC.
Collapse
Affiliation(s)
- Kumar Prabhash
- Department of Medical OncologyTata Memorial HospitalMumbaiMaharashtraIndia
| | - Rebecca Moor
- Mater Cancer Care Centre & Medical Oncology ResearchSouth BrisbaneAustralia
| | - Tuncay Göksel
- Ege University, Faculty of Medicine, Department of Pulmonary MedicineEgeSAM‐Ege University Translational Pulmonary Research CenterBornova‐IzmirTurkey
| | - Jonathan Nyaw
- Department of Clinical OncologyTuen Mun HospitalHong KongHong Kong
| | - Abdullah Khalaf Altwairgi
- Adult Medical Oncology DepartmentComprehensive Cancer Center, King Fahad Medical CityRiyadhSaudi Arabia
| | | | | | | | | |
Collapse
|
5
|
Du Z, Chen S, Qin Y, Lv Y, Du X, Yu H, Liu Z. Efficacy and Safety of Perioperative Immunotherapy for Patients with Non-Small Cell Lung Cancer: A Systematic Review and Network Meta-Analysis. Curr Oncol 2025; 32:184. [PMID: 40136388 PMCID: PMC11940944 DOI: 10.3390/curroncol32030184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2024] [Revised: 02/02/2025] [Accepted: 02/06/2025] [Indexed: 03/27/2025] Open
Abstract
Background: The objective of this study is to indirectly compare the efficacy and safety of all currently available neoadjuvant chemoimmunotherapy and perioperative chemoimmunotherapy in randomized controlled trials (RCTs) involving patients with resectable non-small cell lung cancer (NSCLC) to identify optimal treatment regimens. Methods: Eligible studies evaluating neoadjuvant chemoimmunotherapy and perioperative chemoimmunotherapy-based regimens in resectable NSCLC patients were included. Clinical outcomes were extracted for event-free survival (EFS) and overall survival (OS), as well as the incidence of pathological complete response (pCR), major pathological response (MPR), any-grade adverse events (AEs), and treatment-related adverse events (TRAEs) in the Bayesian framework. A subgroup analysis of EFS was conducted according to PD-L1 expression, histological type and reaching pCR or not. Results: We selected eight RCTs involving 3113 patients. Our analysis found no significant differences between perioperative immunotherapy and neoadjuvant immunotherapy in terms of MPR (RR 0.72, 95% CI 0.39 -1.3), pCR (RR 0.73, 95% CI 0.24-2.3), EFS (HR 0.95, 95% CI 0.56-1.7), and OS (HR 95% CI 3.9-4.2). Subgroup analyses revealed that neoadjuvant immunotherapy demonstrated superiority in the programmed death-ligand 1 (PD-L1) high-expression cohort, the non-squamous cell carcinoma cohort, and the non-smoking cohort. Conversely, perioperative immunotherapy ranked first in the PD-L1 low-expression cohort, squamous cell carcinoma cohort, and non-pCR cohort. Conclusions: Our findings indicate that neoadjuvant immunotherapy and perioperative immunotherapy exhibit comparable efficacy in patients with NSCLC. These results provide valuable evidence for guiding the treatment of patients with resectable NSCLC.
Collapse
Affiliation(s)
- Zhijuan Du
- Medical School of Chinese PLA, Beijing 100853, China
- Department of Medical Oncology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Siyuan Chen
- Medical School of Chinese PLA, Beijing 100853, China
- Department of Medical Oncology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Yuhui Qin
- Medical School of Chinese PLA, Beijing 100853, China
- Department of Medical Oncology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Yahui Lv
- Medical School of Chinese PLA, Beijing 100853, China
- Department of Medical Oncology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Xiangyu Du
- Medical School of Chinese PLA, Beijing 100853, China
- Department of Medical Oncology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Heying Yu
- Department of Medical Oncology, The Third Medical Center of Chinese PLA General Hospital, Beijing 100089, China
| | - Zhefeng Liu
- Department of Medical Oncology, Senior Department of Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| |
Collapse
|
6
|
Marinelli D, Nuccio A, Di Federico A, Ambrosi F, Bertoglio P, Faccioli E, Ferrara R, Ferro A, Giusti R, Guerrera F, Mammana M, Pittaro A, Sepulcri M, Viscardi G, Gallina FT. Improved Event-Free Survival After Complete or Major Pathologic Response in Patients With Resectable NSCLC Treated With Neoadjuvant Chemoimmunotherapy Regardless of Adjuvant Treatment: A Systematic Review and Individual Patient Data Meta-Analysis. J Thorac Oncol 2025; 20:285-295. [PMID: 39389220 DOI: 10.1016/j.jtho.2024.09.1443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 08/14/2024] [Accepted: 09/28/2024] [Indexed: 10/12/2024]
Abstract
INTRODUCTION Neoadjuvant chemoimmunotherapy has reshaped the treatment landscape for resectable NSCLC, yet the prognostic significance of pathologic response remains unclear. We conducted a systematic review and individual patient data (IPD) meta-analysis to evaluate the impact of achieving pathologic complete response (pCR) or major pathologic response (MPR) on event-free survival (EFS) and assessed the influence of adjuvant immunotherapy. METHODS We performed an IPD meta-analysis of prospective clinical trials on neoadjuvant or perioperative anti-programmed death-ligand 1 in combination with platinum-based chemotherapy in patients with resectable NSCLC. The IPD was extracted from Kaplan-Meier curves for pCR and MPR from the included studies. Survival outcomes were compared between patients achieving pCR or MPR and those who did not, considering both intention-to-treat and resected populations. RESULTS Achieving pCR or MPR was associated with improved EFS in the intention-to-treat population (pCR, hazard ratio = 0.13; MPR, hazard ratio = 0.18, respectively) with a 24 months EFS rate of 94% and 88% for patients who achieved pCR and MPR, respectively. Independently from pCR status, patients who were treated in an experimental arm that included adjuvant immunotherapy had similar EFS. CONCLUSIONS Our study reported a strong EFS improvement in patients who achieved either pCR or MPR after neoadjuvant chemoimmunotherapy. The use of adjuvant immunotherapy after tumor resection was not associated with improved EFS.
Collapse
Affiliation(s)
- Daniele Marinelli
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Antonio Nuccio
- Medical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Alessandro Di Federico
- Medical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Francesca Ambrosi
- Pathology Unit, Maggiore Hospital-AUSL Bologna, Bologna, Italy; Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Pietro Bertoglio
- Division of Thoracic Surgery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Alma Mater Studiorum, Università di Bologna, Bologna, Italy
| | - Eleonora Faccioli
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Roberto Ferrara
- Medical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Alessandra Ferro
- Division of Medical Oncology 2, Veneto Institute of Oncology (IOV) - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padova, Italy
| | | | - Francesco Guerrera
- Department of Cardio-Thoracic and Vascular Surgery, Azienda Ospedaliera-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy; Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Marco Mammana
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Alessandra Pittaro
- Department of Medical Sciences, Pathology Unit, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Matteo Sepulcri
- Radiation Oncology Unit, Veneto Institute of Oncology (IOV) - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
| | - Giuseppe Viscardi
- Department of Pneumology and Oncology, Monaldi Hospital, AORN Ospedali dei Colli, Naples, Italy
| | - Filippo Tommaso Gallina
- Thoracic Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) "Regina Elena" National Cancer Institute, Rome, Italy; Division of Thoracic Surgery, McGill University Health Centre, Montreal, QC, Canada.
| |
Collapse
|
7
|
Trabalza Marinucci B, Mancini M, Siciliani A, Messa F, Piccioni G, D’Andrilli A, Maurizi G, Ciccone AM, Menna C, Vanni C, Tiracorrendo M, Rendina EA, Ibrahim M. Surgical Techniques for Non-Small-Cell Lung Cancer After Neoadjuvant Chemo-Immunotherapy: State of Art and Review of the Literature. Cancers (Basel) 2025; 17:638. [PMID: 40002233 PMCID: PMC11853686 DOI: 10.3390/cancers17040638] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2024] [Revised: 01/28/2025] [Accepted: 02/11/2025] [Indexed: 02/27/2025] Open
Abstract
Non-small-cell lung cancer (NSCLC) accounts for 80-85% of all lung cancers. Approximately 20% of patients with NSCLC are diagnosed with stage IIIA-IIIB disease, for which the optimal treatment remains unclear. Meta-analyses reveal that neoadjuvant/perioperative ICI-chemotherapy significantly improves pathological complete response (pCR), overall survival (OS), major pathological response (MPR), and R0 rate compared to standard neoadjuvant chemotherapy. Resectability is achieved when R0 resection can be performed after surgery. Radiographic downstaging often does not correspond to surgical downstaging. In fact, intra-operative fibrosis due to chemo-immunotherapy (synonymous with ICI-chemotherapy) can create adhesions and consequent difficult planes for dissection. Thus, pneumonectomy cannot be avoided. Even the suspicion of N2 after neoadjuvant treatment is considered a limitation of upfront surgery because of the risk of pneumonectomy. The aim of this review is to explore the literature on the technical strategies for surgical excision of NSCLC after chemo-immunotherapy, addressing even the most challenging scenarios.
Collapse
Affiliation(s)
- Beatrice Trabalza Marinucci
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, 00189 Rome, Italy; (A.S.); (F.M.); (G.P.); (A.D.); (G.M.); (A.M.C.); (C.M.); (C.V.); (M.T.); (E.A.R.); (M.I.)
| | - Massimiliano Mancini
- Department of Histopathology, Sant’Andrea Hospital, Sapienza University, 00189 Rome, Italy;
| | - Alessandra Siciliani
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, 00189 Rome, Italy; (A.S.); (F.M.); (G.P.); (A.D.); (G.M.); (A.M.C.); (C.M.); (C.V.); (M.T.); (E.A.R.); (M.I.)
| | - Fabiana Messa
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, 00189 Rome, Italy; (A.S.); (F.M.); (G.P.); (A.D.); (G.M.); (A.M.C.); (C.M.); (C.V.); (M.T.); (E.A.R.); (M.I.)
| | - Giorgia Piccioni
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, 00189 Rome, Italy; (A.S.); (F.M.); (G.P.); (A.D.); (G.M.); (A.M.C.); (C.M.); (C.V.); (M.T.); (E.A.R.); (M.I.)
| | - Antonio D’Andrilli
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, 00189 Rome, Italy; (A.S.); (F.M.); (G.P.); (A.D.); (G.M.); (A.M.C.); (C.M.); (C.V.); (M.T.); (E.A.R.); (M.I.)
| | - Giulio Maurizi
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, 00189 Rome, Italy; (A.S.); (F.M.); (G.P.); (A.D.); (G.M.); (A.M.C.); (C.M.); (C.V.); (M.T.); (E.A.R.); (M.I.)
| | - Anna Maria Ciccone
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, 00189 Rome, Italy; (A.S.); (F.M.); (G.P.); (A.D.); (G.M.); (A.M.C.); (C.M.); (C.V.); (M.T.); (E.A.R.); (M.I.)
| | - Cecilia Menna
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, 00189 Rome, Italy; (A.S.); (F.M.); (G.P.); (A.D.); (G.M.); (A.M.C.); (C.M.); (C.V.); (M.T.); (E.A.R.); (M.I.)
| | - Camilla Vanni
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, 00189 Rome, Italy; (A.S.); (F.M.); (G.P.); (A.D.); (G.M.); (A.M.C.); (C.M.); (C.V.); (M.T.); (E.A.R.); (M.I.)
| | - Matteo Tiracorrendo
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, 00189 Rome, Italy; (A.S.); (F.M.); (G.P.); (A.D.); (G.M.); (A.M.C.); (C.M.); (C.V.); (M.T.); (E.A.R.); (M.I.)
| | - Erino Angelo Rendina
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, 00189 Rome, Italy; (A.S.); (F.M.); (G.P.); (A.D.); (G.M.); (A.M.C.); (C.M.); (C.V.); (M.T.); (E.A.R.); (M.I.)
| | - Mohsen Ibrahim
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, 00189 Rome, Italy; (A.S.); (F.M.); (G.P.); (A.D.); (G.M.); (A.M.C.); (C.M.); (C.V.); (M.T.); (E.A.R.); (M.I.)
| |
Collapse
|
8
|
Gallina FT, Cecere FL, Tajè R, Bertolaccini L, Casiraghi M, Spaggiari L, Cannone G, Busetto A, Rea F, Martucci N, De Luca G, Mercadante E, Mazzoni F, Bongiolatti S, Voltolini L, Melis E, Sperduti I, Cappuzzo F, Rayes R, Ferri L, Facciolo F, Spicer J. Predictive and prognostic factors in patients with anaplastic lymphoma kinase rearranged early-stage lung adenocarcinoma. Eur J Cardiothorac Surg 2024; 66:ezae406. [PMID: 39531280 DOI: 10.1093/ejcts/ezae406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 10/15/2024] [Accepted: 11/09/2024] [Indexed: 11/16/2024] Open
Abstract
OBJECTIVES This study aimed to evaluate the predictive and prognostic factors in clinical stage I, anaplastic lymphoma kinase (ALK)-rearranged lung adenocarcinoma following radical surgery. Additionally, it sought to compare these factors with an external cohort of ALK wild-type patients. METHODS A multicentric, retrospective, case-control analysis was conducted on patients with clinical T1-2 N0 ALK-rearranged lung adenocarcinoma who underwent anatomical resection and radical lymphadenectomy. Data were collected from 5 high-volume oncological centres. An external cohort of ALK wild-type patients was also analysed for comparison. Survival analyses were performed using the Kaplan-Meier method, and multivariable Cox regression analysis was used to identify prognostic factors. RESULTS From January 2016 to December 2022, 63 patients with ALK-rearranged lung adenocarcinoma were included. High-grade tumours (G3) significantly associated with upstaging (odds ratio = 3.904, P = 0.04). Disease-free survival (DFS) and overall survival were significantly improved in upstaged patients receiving adjuvant treatment [hazard ratio (HR) = 0.18, P = 0.0042; HR = 0.24, P = 0.0004, respectively]. The solid or micropapillary histological subtypes were independently associated with worse DFS (HR = 3.41, P = 0.022). Comparison with 435 ALK wild-type patients showed worse DFS in the ALK-rearranged group (HR = 2.09, P = 0.0003). ALK-rearranged patients had higher rates of nodal upstaging, systemic and brain recurrences. CONCLUSIONS Clinical T1-2 N0 ALK-rearranged lung adenocarcinoma is an aggressive disease with a specific tropism for lymph nodes and the brain. High-grade tumours are predictive of nodal upstaging. Adjuvant treatment significantly improves DFS and overall survival in upstaged patients, highlighting the need for personalized preoperative staging and post-surgical management in this cohort.
Collapse
Affiliation(s)
| | - Fabiana Letizia Cecere
- Department of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Riccardo Tajè
- Department of Thoracic Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Monica Casiraghi
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Giorgio Cannone
- Thoracic Surgery and Lung Transplantation Unit, University-Hospital of Padova, Padova, Italy
| | - Alberto Busetto
- Thoracic Surgery and Lung Transplantation Unit, University-Hospital of Padova, Padova, Italy
| | - Federico Rea
- Thoracic Surgery and Lung Transplantation Unit, University-Hospital of Padova, Padova, Italy
| | - Nicola Martucci
- Thoracic Surgery Unit, Istituto Nazionale Tumori, "Fondazione G. Pascale"-IRCCS, Napoli, Italy
| | - Giuseppe De Luca
- Thoracic Surgery Unit, Istituto Nazionale Tumori, "Fondazione G. Pascale"-IRCCS, Napoli, Italy
| | - Edoardo Mercadante
- Thoracic Surgery Unit, Istituto Nazionale Tumori, "Fondazione G. Pascale"-IRCCS, Napoli, Italy
| | - Francesca Mazzoni
- Oncology Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | | | - Luca Voltolini
- Thoracic Surgery Unit, University Hospital Careggi, Florence, Italy
| | - Enrico Melis
- Department of Thoracic Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Isabella Sperduti
- Biostatistics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Federico Cappuzzo
- Department of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Roni Rayes
- Division of Thoracic Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Lorenzo Ferri
- Division of Thoracic Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Francesco Facciolo
- Department of Thoracic Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Jonathan Spicer
- Division of Thoracic Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| |
Collapse
|
9
|
Meng Y, Zhang Q, Wu R, Li H, Wang Z, Yao Y, Li X, Chen Z, Gong Y, Liu H. Efficacy and safety of perioperative, neoadjuvant, or adjuvant immunotherapy alone or in combination with chemotherapy in early-stage non-small cell lung cancer: a systematic review and meta-analysis of randomized clinical trials. Ther Adv Med Oncol 2024; 16:17588359241284929. [PMID: 39376583 PMCID: PMC11457281 DOI: 10.1177/17588359241284929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 09/03/2024] [Indexed: 10/09/2024] Open
Abstract
Background Neoadjuvant (NE), adjuvant (AD), and perioperative (PE) immunotherapies have gained validation in early-stage non-small cell lung cancer (NSCLC) trials. However, a comprehensive assessment of their comparative efficacy and safety is lacking. Objectives To compare the efficacy and safety of NE, AD, and PE immunotherapies in early-stage NSCLC. Design A systematic review and network meta-analysis using a Bayesian framework. Data sources and methods We searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) of immune checkpoint inhibitors plus chemotherapy (CT) for early-stage NSCLC. Hazard ratios (HRs) and odds ratios (ORs) for binary endpoints with 95% confidence intervals (CIs) were calculated. Results We included 10 RCTs involving 5569 NSCLC patients, categorized as NE, PE, or AD immunotherapy. Indirect comparisons highlighted differences in efficacy between PE and AD immunotherapy, specifically in event-free survival (EFS)/disease-free survival (DFS) (HR = 0.72, 95% CI: 0.53-0.96). NE/PE immunotherapies improved pathologic complete response (pCR) (OR = 7.56, 95% CI: 5.24-10.92), major pathologic response (MPR) (OR = 5.46, 95% CI: 3.97-7.51), and EFS (HR = 0.58, 95% CI: 0.52-0.65), while AD immunotherapy enhanced DFS (HR = 0.78, 95% CI: 0.69-0.90). Overall survival (OS) benefits were seen only with PE immunotherapy (HR = 0.66, 95% CI: 0.55-0.81). PE treatment improved EFS across various subgroups (PD-L1 < 1%, IIIB, squamous, female, without MPR/pCR, epidermal growth factor receptor (EGFR) mutant-negative), except EGFR mutant-positive NSCLC (HR = 0.54, 95% CI: 0.21-1.43). AD (OR = 1.81, 95% CI: 1.20-2.73) and PE (OR = 1.28, 95% CI: 1.10-1.50) immunotherapies were associated with higher grade ⩾3 adverse events. Conclusion In the three treatment modalities, PE immunotherapy appears to be more effective than AD immunotherapy, with PE showing significant advantages in certain subgroups that NE does not. NE and PE immunotherapy significantly improved pCR, MPR, and EFS, while AD immunotherapy significantly improved DFS in NSCLC patients compared to the control group. However, only PE immunotherapy significantly improved OS. Differences in efficacy between NE and PE across the entire population of resectable NSCLC remain to be explored in additional studies.
Collapse
Affiliation(s)
- Yunchang Meng
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Qingfeng Zhang
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Ranpu Wu
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Southeast University School of Medicine, Nanjing, China
| | - Huijuan Li
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Zhaofeng Wang
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yang Yao
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Xinjing Li
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhangxuan Chen
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yanzhuo Gong
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing University of Chinese Medicine, Nanjing, China
| | - Hongbing Liu
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing Medical University, 305 East Zhongshan Road, Nanjing 210000, China
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing 210000, China
| |
Collapse
|
10
|
Spicer JD, Cascone T, Wynes MW, Ahn MJ, Dacic S, Felip E, Forde PM, Higgins KA, Kris MG, Mitsudomi T, Provencio M, Senan S, Solomon BJ, Tsao MS, Tsuboi M, Wakelee HA, Wu YL, Chih-Hsin Yang J, Zhou C, Harpole DH, Kelly KL. Neoadjuvant and Adjuvant Treatments for Early Stage Resectable NSCLC: Consensus Recommendations From the International Association for the Study of Lung Cancer. J Thorac Oncol 2024; 19:1373-1414. [PMID: 38901648 DOI: 10.1016/j.jtho.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 06/07/2024] [Accepted: 06/13/2024] [Indexed: 06/22/2024]
Abstract
Advances in the multidisciplinary care of early stage resectable NSCLC (rNSCLC) are emerging at an unprecedented pace. Numerous phase 3 trials produced results that have transformed patient outcomes for the better, yet these findings also require important modifications to the patient treatment journey trajectory and reorganization of care pathways. Perhaps, most notably, the need for multispecialty collaboration for this patient population has never been greater. These rapid advances have inevitably left us with important gaps in knowledge for which definitive answers will only become available in several years. To this end, the International Association for the Study of Lung Cancer commissioned a diverse multidisciplinary international expert panel to evaluate the current landscape and provide diagnostic, staging, and therapeutic recommendations for patients with rNSCLC, with particular emphasis on patients with American Joint Committee on Cancer-Union for International Cancer Control TNM eighth edition stages II and III disease. Using a team-based approach, we generated 19 recommendations, of which all but one achieved greater than 85% consensus among panel members. A public voting process was initiated, which successfully validated and provided qualitative nuance to our recommendations. Highlights include the following: (1) the critical importance of a multidisciplinary approach to the evaluation of patients with rNSCLC driven by shared clinical decision-making of a multispecialty team of expert providers; (2) biomarker testing for rNSCLC; (3) a preference for neoadjuvant chemoimmunotherapy for stage III rNSCLC; (4) equipoise regarding the optimal management of patients with stage II between upfront surgery followed by adjuvant therapy and neoadjuvant or perioperative strategies; and (5) the robust preference for adjuvant targeted therapy for patients with rNSCLC and sensitizing EGFR and ALK tumor alterations. Our primary goals were to provide practical recommendations sensitive to the global differences in biology and resources for patients with rNSCLC and to provide expert consensus guidance tailored to the individualized patient needs, goals, and preferences in their cancer care journey as these are areas where physicians must make daily clinical decisions in the absence of definitive data. These recommendations will continue to evolve as the treatment landscape for rNSCLC expands and more knowledge is acquired on the best therapeutic approach in specific patient and disease subgroups.
Collapse
Affiliation(s)
- Jonathan D Spicer
- Division of Thoracic Surgery and Upper GI Surgery, Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Tina Cascone
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Murry W Wynes
- Scientific Affairs, International Association for the Study of Lung Cancer, Denver, Colorado
| | - Myung-Ju Ahn
- Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea
| | - Sanja Dacic
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Enriqueta Felip
- Oncology Department, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Patrick M Forde
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kristin A Higgins
- Department of Radiation Oncology, Emory University, Winship Cancer Institute, Atlanta, Georgia
| | - Mark G Kris
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Tetsuya Mitsudomi
- Izumi City General Hospital, Izumi, Osaka, Japan; Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Mariano Provencio
- Medical Oncology Department, Puerta de Hierro University Teaching Hospital, Majadahonda, Spain
| | - Suresh Senan
- Cancer Center Amsterdam, Department of Radiation Oncology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Benjamin J Solomon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Ming Sound Tsao
- Department of Pathology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Masahiro Tsuboi
- Department of Thoracic Surgery and Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Heather A Wakelee
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California; Stanford Cancer Institute, Stanford, California
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - James Chih-Hsin Yang
- Department of Oncology, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Taiwan
| | - Caicun Zhou
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - David H Harpole
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Karen L Kelly
- Scientific Affairs, International Association for the Study of Lung Cancer, Denver, Colorado.
| |
Collapse
|
11
|
Chen K, Wang X, Yue R, Chen W, Zhu D, Cui S, Zhang X, Jin Z, Xiao T. Efficacy and safety of immune checkpoint inhibitors as neoadjuvant therapy in perioperative patients with non-small cell lung cancer: a network meta-analysis and systematic review based on randomized controlled trials. Front Immunol 2024; 15:1432813. [PMID: 39416776 PMCID: PMC11480955 DOI: 10.3389/fimmu.2024.1432813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 09/17/2024] [Indexed: 10/19/2024] Open
Abstract
Background Randomized controlled trials (RCTs) have unequivocally established the therapeutic advantages of combining immune checkpoint inhibitors (ICIs) with chemotherapy in the treatment of early-stage non-small cell lung cancer (NSCLC). Presently, numerous perioperative immunotherapy regimens centered around the integration of ICIs and chemotherapy have undergone clinical trials. Nonetheless, due to the absence of direct comparative RCTs among these treatment regimens, this study aims to employ Bayesian network meta-analysis to ascertain the optimal combination of ICIs and chemotherapy. Methods A systematic literature search was conducted in PubMed, EMBASE, Cochrane Library, Web of Science databases, and major international conference publications up to April 10, 2024. This comprehensive search yielded a total of 1434 studies. Following a rigorous screening process that involved evaluating the studies for relevance, methodological quality, and alignment with our research objectives, 8 studies were carefully selected for inclusion in the final analysis. Based on these curated search results, a systematic review and network meta-analysis were conducted. Results 8 RCTs were included, encompassing 7 treatments and involving 3699 operable NSCLC patients at stages I-III. Compared to chemotherapy alone, perioperative immunotherapy demonstrated higher efficacy. The combination of toripalimab and chemotherapy showed the most significant improvement in event-free survival (EFS) (HR= 0.40; 95% CI, 0.28-0.58). The regimen that most notably enhanced overall survival (OS) was Nivolumab combined with chemotherapy (HR = 0.62; 95% CI, 0.36-1.07). In terms of pathological complete response (pCR), the combination of Toripalimab and chemotherapy exhibited the highest benefit (OR = 32.89; 95% CI, 7.88-137.32). Regarding the improvement in R0 resection, Pembrolizumab plus chemotherapy performed most prominently(OR=2.15; 95% CI, 1.30-3.56). In terms of the incidence of grade 3 or higher adverse events, durvalumab combined with chemotherapy had the lowest incidence (OR = 1.05; 95% CI, 0.79-1.38), while the incidence for other regimens was higher than chemotherapy alone. Conclusion The efficacy of perioperative immunotherapy plus chemotherapy in patients with early NSCLC is significantly improved compared to chemotherapy alone. Although there is a certain risk of adverse events, the safety is within a controllable range. After a comprehensive evaluation of five endpoints in this study, it is believed that the combination of Toripalimab or Nivolumab with chemotherapy may be the optimal immunotherapy regimen for the treatment of stage Ib-IIIb NSCLC. These findings will help guide the design of clinical treatment plans and ICIs selection. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier CRD42024536799.
Collapse
Affiliation(s)
- Kaiqi Chen
- School of Basic Medical, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xinwei Wang
- School of Basic Medical, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Rui Yue
- Department of Traditional Chinese Medicine, Chongqing Changhang Hospital, Chongqing, China
| | - Wei Chen
- Department of Pharmacy, Emergency General Hospital, Beijing, China
| | - Danping Zhu
- Department of Endocrinology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Shikui Cui
- Department of Endocrinology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Xijian Zhang
- Department of Endocrinology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Zhao Jin
- School of Basic Medical, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Tong Xiao
- School of Basic Medical Sciences, Capital Medical University, Beijing, China
| |
Collapse
|
12
|
D'Amours MF, Wu FTH, Theisen-Lauk O, Chan EK, McGuire A, Ho C. Surgically resectable nonsmall cell lung cancer: a contemporary approach. Eur Respir J 2024; 64:2400332. [PMID: 38843914 DOI: 10.1183/13993003.00332-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/28/2024] [Indexed: 07/28/2024]
Abstract
New treatment paradigms for resectable nonsmall cell lung cancer (NSCLC), with an emphasis on personalised care and a multidisciplinary approach, have significantly improved patient outcomes. The incorporation of immune checkpoint inhibitors into neoadjuvant, perioperative and adjuvant treatment algorithms is reshaping the standard of care for resectable NSCLC. Adjuvant targeted therapy trials have also paved the way for a much-needed personalised approach for patients with actionable genomic alterations. Innovative surgical techniques and judicious use of postoperative radiotherapy may mitigate the toxicity associated with a multimodality approach. Amid the many new treatment options, questions remain about the best approach to consider for each patient. Measurement of minimal residual disease and achievement of pathological complete response are emerging biomarkers of interest to help further refine treatment selection. This review summarises the current management of resectable NSCLC, focusing on ongoing and recent advances in surgical approaches, the role of postoperative radiotherapy and the rapidly changing field of systemic therapies.
Collapse
Affiliation(s)
| | - Florence T H Wu
- Department of Medical Oncology, BC Cancer Agency Vancouver, Vancouver, BC, Canada
| | - Olivia Theisen-Lauk
- Department of Thoracic Surgery, University Hospital of Zürich, Zürich, Switzerland
| | - Elisa K Chan
- Department of Radiation Oncology, BC Cancer Agency Vancouver, Vancouver, BC, Canada
- University of British Columbia, Vancouver, BC, Canada
| | - Anna McGuire
- University of British Columbia, Vancouver, BC, Canada
- Department of Thoracic Surgery, Vancouver General Hospital, Vancouver, BC, Canada
| | - Cheryl Ho
- Department of Medical Oncology, BC Cancer Agency Vancouver, Vancouver, BC, Canada
- University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
13
|
Gallina FT, Balzano V, Porciello N, Tajè R, Forcella D, Melis E, Letizia Cecere F, Fusco F, Buglioni S, Visca P, Nisticò P, Cappuzzo F, Spicer J. Trajectory of PD-L1 expression in a patient underwent neoadjuvant chemo-immunotherapy for resectable NSCLC. Lung Cancer 2024; 194:107900. [PMID: 39079181 DOI: 10.1016/j.lungcan.2024.107900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Accepted: 07/24/2024] [Indexed: 04/04/2025]
Affiliation(s)
- Filippo Tommaso Gallina
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy; Division of Thoracic Surgery, McGill University Health Centre, Montreal, QC, Canada.
| | - Vittoria Balzano
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Nicla Porciello
- Tumor Immunology and Immunotherapy Unit, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Riccardo Tajè
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Daniele Forcella
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Enrico Melis
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Francesca Fusco
- Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Simonetta Buglioni
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Paolo Visca
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Paola Nisticò
- Tumor Immunology and Immunotherapy Unit, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Federico Cappuzzo
- Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Jonathan Spicer
- Division of Thoracic Surgery, McGill University Health Centre, Montreal, QC, Canada
| |
Collapse
|
14
|
Zhang W, Liang Z, Zhao Y, Li Y, Chen T, Li W, Chen Y, Wu P, Zhang H, Fang C, Li L. Efficacy and safety of neoadjuvant immunotherapy plus chemotherapy followed by adjuvant immunotherapy in resectable non-small cell lung cancer: a meta-analysis of phase 3 clinical trials. Front Immunol 2024; 15:1359302. [PMID: 38646542 PMCID: PMC11026587 DOI: 10.3389/fimmu.2024.1359302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/25/2024] [Indexed: 04/23/2024] Open
Abstract
Objective At present, several important trials have been published show that perioperative immunotherapy combined with chemotherapy can improve the prognosis of patients with resectable non-small cell lung cancer, which further optimizes treatment options. Therefore, we conducted a systematic review and meta-analysis to evaluate the efficacy and safety of perioperative immunotherapy combined with chemotherapy in resectable non-small cell lung cancer. Methods The following databases were searched for relevant studies: PubMed, EMBASE, Cochrane library (updated 12 October 2023). All randomized trials comparing perioperative immunotherapy combined with chemotherapy versus chemotherapy alone in resectable non-small cell lung cancer were eligible for inclusion. Data were analyzed using Review Manager 5.4.1 (Cochrane collaboration software). Primary outcomes and measures included overall survival (OS), event-free survival (EFS), pathological complete response (pCR), major pathological response (MPR), R0 resection rate, rate of underwent surgery and adverse events (AEs). Results A total of 2912 patients (1453 receiving perioperative immunotherapy plus chemotherapy and 1459 receiving chemotherapy alone) were included in this systematic review and meta-analysis. The result showed that compared with chemotherapy alone, combined therapy significantly improved OS (HR = 0.68;95% CI: 0.56-0.83), EFS (HR = 0.58;95% CI: 0.51-0.65), pCR (OR = 7.53;95% CI: 4.63-12.26), MPR (OR = 5.03;95% CI: 3.40-7.44), R0 resection (OR = 1.58;95% CI: 1.152.18) and rate of underwent surgery (OR = 1.25;95% CI: 1.04-1.49). However, combination therapy was associated with higher risk of severe adverse event (OR = 1.46;95% CI: 1.19-1.78; P=0.0002), grade 3 and higher treatment-related adverse event (TRAE) (OR = 1.25;95% CI: 1.06-1.49; P=0.010), TRAE that led to interruption (OR = 1.90;95% CI: 1.34-2.68; P=0.0003) and immune-related adverse event (OR = 2.78;95% CI: 2.18-3.55; P<0.00001). Significant benefits were observed across most subgroups of EFS and pCR. However, no statistical differences were observed for EFS of never smoked (HR = 0.73;95% CI: 0.51-1.05) and EGFR-mutation positive (HR = 0.35;95% CI: 0.04-3.03). Conclusion This systematic review and meta-analysis found superior efficacy associated with perioperative immunotherapy plus chemotherapy compared with chemotherapy alone in both tumor regression and prolonged survival in resectable NSCLC, but increased the risk of TRAE, so monitoring for adverse events is warranted. Systematic review registration https://www.crd.york.ac.uk/prospero, identifier (CRD42023476786).
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Luzhen Li
- Department of Oncology, Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine, Guangdong, China
| |
Collapse
|
15
|
Banna GL, Hassan MA, Signori A, Giunta EF, Maniam A, Anpalakhan S, Acharige S, Ghose A, Addeo A. Neoadjuvant Chemo-Immunotherapy for Early-Stage Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis. JAMA Netw Open 2024; 7:e246837. [PMID: 38625698 PMCID: PMC11022115 DOI: 10.1001/jamanetworkopen.2024.6837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/15/2024] [Indexed: 04/17/2024] Open
Abstract
Importance Randomized clinical trials (RCTs) with neoadjuvant immune checkpoint inhibitors (ICIs) plus chemotherapy (ICI-chemotherapy) for patients with early-stage non-small cell lung cancer (NSCLC) have reported consistent associations with event-free survival (EFS) and pathologic complete response (pCR) pending longer follow-up for overall survival data. Objective To assess the pooled benefit of ICI-chemotherapy in 2-year EFS and pCR among patients with NSCLC and examine the impact of clinical, pathologic, and treatment-related factors. Data Sources Full-text articles and abstracts in English were searched in EMBASE, PubMed, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews through November 1, 2023, and in oncology conference proceedings from January 1, 2008, to November 1, 2023. Study Selection Phase 2 or 3 RCTs with neoadjuvant ICI-chemotherapy with or without adjuvant ICIs vs neoadjuvant chemotherapy alone with or without placebo or observation in patients with previously untreated NSCLC staged IB to IIIB were included. Data Extraction and Synthesis Data extraction of prespecified data elements was performed by 2 reviewers using a structured data abstraction electronic form. A random-effects model was used for meta-analysis. The meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Main Outcomes and Measures Two-year EFS and pCR were the outcomes of interest in patients who received neoadjuvant ICI-chemotherapy (experimental arm) or neoadjuvant chemotherapy alone (control arm). Aggregated pooled hazard ratios (HRs) for time-to-event outcomes (2-year EFS) and risk ratios (RRs) for dichotomous outcomes (pCR) with their respective 95% CIs were calculated. Results Eight trials with 3387 patients were included, with some concerns of risk of bias as assessed by the Cochrane Collaboration method, mainly related to outcomes measurements. Neoadjuvant ICI-chemotherapy was associated with improved 2-year EFS (HR, 0.57; 95% CI, 0.50-0.66; P < .001) and increased pCR rate (RR, 5.58; 95% CI, 4.27-7.29; P < .001) in the experimental vs control treatment arms. This association was not significantly modified by the main patient characteristics; tumor- or treatment-related factors, including tumor programmed cell death ligand 1 (PD-L1) status; type of platinum-compound chemotherapy; number of cycles of neoadjuvant ICI-chemotherapy; or addition of adjuvant ICIs. Patients whose tumor cells were negative for PD-L1 were at higher risk of relapse (HR, 0.75; 95% CI, 0.62-0.91) than were those with low (HR, 0.61; 95% CI, 0.37-0.71) or high PD-L1 (HR, 0.40; 95% CI, 0.27-0.58) (P = .005). Conclusions and Relevance In this systematic review and meta-analysis of neoadjuvant ICI-chemotherapy RCTs in patients with early-stage NSCLC, 3 cycles of neoadjuvant platinum-based ICI-chemotherapy were associated with a meaningful improvement in 2-year EFS and pCR.
Collapse
Affiliation(s)
- Giuseppe Luigi Banna
- Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
- Faculty of Science and Health, School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, United Kingdom
| | - Mona Ali Hassan
- Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
| | - Alessio Signori
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Emilio Francesco Giunta
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori,” Meldola, Italy
| | - Akash Maniam
- Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
| | - Shobana Anpalakhan
- Department of Oncology, Southampton General Hospital, Southampton, United Kingdom
| | - Shyamika Acharige
- Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
| | - Aruni Ghose
- Department of Medical Oncology, Barts Cancer Centre, St Bartholomew’s Hospital, London, United Kingdom
| | - Alfredo Addeo
- Oncology Service, Geneva University Hospital, Geneva, Switzerland
| |
Collapse
|
16
|
Verma S, Breadner D, Mittal A, Palma DA, Nayak R, Raphael J, Vincent M. An Updated Review of Management of Resectable Stage III NSCLC in the Era of Neoadjuvant Immunotherapy. Cancers (Basel) 2024; 16:1302. [PMID: 38610980 PMCID: PMC11010993 DOI: 10.3390/cancers16071302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/15/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Immune-checkpoint inhibitors (ICIs) have an established role in the treatment of locally advanced and metastatic non-small cell lung cancer (NSCLC). ICIs have now entered the paradigm of early-stage NSCLC. The recent evidence shows that the addition of ICI to neoadjuvant chemotherapy improves the pathological complete response (pCR) rate and survival rate in early-stage resectable NSCLC and is now a standard of care option in this setting. In this regard, stage III NSCLC merits special consideration, as it is heterogenous and requires a multidisciplinary approach to management. As the neoadjuvant approach is being adopted widely, new challenges have emerged and the boundaries for resectability are being re-examined. Consequently, it is ever more important to carefully individualize the treatment strategy for each patient with resectable stage III NSCLC. In this review, we discuss the recent literature in this field with particular focus on evolving definitions of resectability, T4 disease, N2 disease (single and multi-station), and nodal downstaging. We also highlight the controversy around adjuvant treatment in this setting and discuss the selection of patients for adjuvant treatment, options of salvage, and next line treatment in cases of progression on/after neoadjuvant treatment or after R2 resection. We will conclude with a brief discussion of predictive biomarkers, predictive models, ongoing studies, and directions for future research in this space.
Collapse
Affiliation(s)
- Saurav Verma
- Division of Medical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada; (S.V.); (D.B.); (J.R.)
- London Regional Cancer Program, London Health Sciences Centre, London, ON N6A 5W9, Canada; (D.A.P.); (R.N.)
| | - Daniel Breadner
- Division of Medical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada; (S.V.); (D.B.); (J.R.)
- London Regional Cancer Program, London Health Sciences Centre, London, ON N6A 5W9, Canada; (D.A.P.); (R.N.)
| | - Abhenil Mittal
- Division of Medical Oncology, Northeast Cancer Centre, Ramsey Lake Health Centre, Sudbury, ON P3E 5J1, Canada;
| | - David A. Palma
- London Regional Cancer Program, London Health Sciences Centre, London, ON N6A 5W9, Canada; (D.A.P.); (R.N.)
- Division of Radiation Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada
| | - Rahul Nayak
- London Regional Cancer Program, London Health Sciences Centre, London, ON N6A 5W9, Canada; (D.A.P.); (R.N.)
- Division of Thoracic Surgery, Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada
| | - Jacques Raphael
- Division of Medical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada; (S.V.); (D.B.); (J.R.)
- London Regional Cancer Program, London Health Sciences Centre, London, ON N6A 5W9, Canada; (D.A.P.); (R.N.)
| | - Mark Vincent
- Division of Medical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada; (S.V.); (D.B.); (J.R.)
- London Regional Cancer Program, London Health Sciences Centre, London, ON N6A 5W9, Canada; (D.A.P.); (R.N.)
| |
Collapse
|