IASLC Multidisciplinary Recommendations for Pathologic Assessment of Lung Cancer Resection Specimens After Neoadjuvant Therapy

Advancing the understanding of the role of apoptosis in lung cancer immunotherapy: Global research trends, key themes, and emerging frontiers

Apoptosis is vital for improving the efficacy of lung cancer (LC) immunotherapy by targeting cancer cell elimination. Despite its importance, there is a lack of comprehensive bibliometric studies analyzing global research on apoptosis in LC immunotherapy. This analysis aims to address this gap by highlighting key trends, contributors, and future directions. A total of 969 publications from 1996 to 2024 were extracted from the Web of Science Core Collection. Analysis was conducted using VOSviewer, CiteSpace, and the R package 'bibliometrix.' The study included contributions from 6,894 researchers across 1,469 institutions in 61 countries, with research published in 356 journals. The volume of publications has steadily increased, led by China and the United States, with Sichuan University as the top contributor. The journal Cancers published the most articles, while Cancer Research had the highest co-citations. Yu-Quan Wei was the leading author, and Jemal, A. was the most frequently co-cited. Key research themes include "cell death mechanisms," "immune regulation," "combination therapies," "gene and nanomedicine applications," and "traditional Chinese medicine (TCM)." Future research is likely to focus on "coordinated regulation of multiple cell death pathways," "modulation of the tumor immune microenvironment," "optimization of combination therapies," "novel strategies in gene regulation," and the "integration of TCM" for personalized treatment. This is the first bibliometric analysis on the role of apoptosis in LC immunotherapy, providing an landscape of global research patterns and emerging therapeutic strategies. The findings offer insights to guide future research and optimize treatment approaches.

Adjuvant immunotherapy does not improve survival in non-small cell lung cancer with major/complete pathologic response after induction immunotherapy

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.

Efficacy of radiolabelled PD-L1-targeted nanobody in predicting and evaluating the combined immunotherapy and chemotherapy for resectable non-small cell lung cancer

BACKGROUND

This study aimed to assess the predictive and evaluative value of PD-L1 targeted 68Ga-THP-APN09 PET/CT in the neoadjuvant immunotherapy combined with chemotherapy for resectable non-small cell lung cancer (NSCLC), and to explore its potential in indicating immunotherapy-related adverse effects (irAEs).

METHODS

Fifty patients with resectable NSCLC enrolled in this prospective study underwent baseline 68Ga-THP-APN09 PET/CT and 18F-FDG PET/CT, with follow-up 18F-FDG PET/CT conducted, additionally, 36 patients received follow-up 68Ga-THP-APN09 PET/CT. Surgery was performed following 2-4 cycles of toripalimab combined with chemotherapy if R0 resection was feasible. The major pathologic response (MPR) state of the post-operative specimen and the adverse effects following combined therapy were documented. The correlation between PD-L1 expression and baseline 68Ga-THP-APN09 PET/CT uptake was determined. The predictive and evaluative efficacies of baseline and follow-up 68Ga-THP-APN09 PET/CT, along with 18F-FDG PET/CT, in determining MPR, were compared.

RESULTS

The SUVmax values of baseline 68Ga-THP-APN09 PET/CT were significantly higher in patients exhibiting high-positive PD-L1 expression compared to those with low-positive and negative expression (P = 0.001). And the SUVmax values of baseline 68Ga-THP-APN09 PET/CT in the response group, as determined by 18F-FDG PET/CT evaluation, were significantly higher than those in the non-response group (3.4 vs. 2.4, P < 0.001). Totally, 41 patients underwent surgery, of which 27 achieved MPR, while 14 did not. The SUVmax in baseline 68Ga-THP-APN09 PET/CT demonstrated statistical significance between the MPR and non-MPR groups, with area under the ROC curve (AUC) of 0.88 (95%CI: 0.77-0.99) in identifying MPR. However, the SUVmax in baseline 18F-FDG PET/CT failed to demonstrated significant predictive power, with AUC values of 0.68 (95%CI: 0.50-0.86, P = 0.076). While the SUVmax in follow-up 68Ga-THP-APN09 and 18F-FDG PET/CT, along with their change rate (ΔSUVmax%), demonstrated good predictive efficacy in identifying MPR, with AUC values of 0.81 (0.64-0.98), 0.91 (0.82-1.00), 0.93 (0.84-1.00), and 0.96 (0.89-1.00), respectively. Furthermore, the follow-up 68Ga-THP-APN09 PET/CT could remarkedly indicate the potential for thyroiditis.

CONCLUSION

Baseline 68Ga-THP-APN09 PET/CT alone could predict efficacy and assist in patient screening for immunotherapy combined chemotherapy in resectable NSCLC, and the follow-up 68Ga-THP-APN09 PET/CT and their change rates could aid in therapy evaluation. Additionally, follow-up 68Ga-THP-APN09 PET/CT could be utilized to monitor the immunotherapy-related thyroiditis during the therapy.

TRIAL REGISTRATION

NCT05156515, registered 8 December 2021, https://register.

CLINICALTRIALS

gov/prs/app/action/SelectProtocol?sid=S000BMSI%26;selectaction=Edit%26;uid=U000503E%26;ts=2%26;cx=zeghuw .

A single-cell atlas reveals immune heterogeneity in anti-PD-1-treated non-small cell lung cancer

Anti-PD-(L)1 treatment is standard for non-small cell lung cancer (NSCLC), but patients show variable responses to the same regimen. The tumor immune microenvironment (TIME) is associated with immunotherapy response, yet the heterogeneous underlying therapeutic outcomes remain underexplored. We applied single-cell RNA and TCR sequencing (scRNA/TCR-seq) to analyze surgical tumor samples from 234 NSCLC patients post-neoadjuvant chemo-immunotherapy. Analyses revealed five distinct TIME subtypes with varying major pathological response (MPR) rates. MPR patients had elevated levels of FGFBP2+ NK/NK-like T cells, memory B cells, or effector T cells, while non-MPR patients showed higher CCR8+ Tregs. T cell clonal expansion analyses unveiled heterogeneity in non-MPR patients, marked by varying expansions of Tex-relevant cells and CCR8+ Tregs. Precursor exhausted T cells (Texp cells) correlated with recurrence-free survival, identifying a patient subgroup with reduced recurrence risk despite lack of MPR. Our study dissects TIME heterogeneity in response to chemoimmunotherapy, offering insights for NSCLC management.

Clinical outcomes of conversion surgery following neoadjuvant chemoimmunotherapy in potentially resectable stage IIIA/IIIB non-small cell lung

Neoadjuvant chemoimmunotherapy has been successfully used in patients with resectable non-small-cell lung cancer (NSCLC). However, its application to potentially resectable IIIA/IIIB NSCLC remains controversial. This retrospective study aims to evaluate the efficacy and safety of neoadjuvant chemoimmunotherapy followed by conversion surgery in patients with potentially resectable stage III NSCLC, focusing on conversion rate and survival benefits. Patients with 'potentially resectable' stage IIIA/IIIB NSCLC who were deemed unsuitable for complete (R0) resection at initial diagnosis were retrospectively identified. After 2-4 cycles of treatment, all patients were reevaluated for surgical resectability. Data on patient characteristics, radiological and pathological responses, and survival outcomes were collected. In total, 148 patients were included in the final analysis. Upon the completion of neoadjuvant therapy, 105 patients were considered suitable for conversion surgery. Three patients refused surgery, and 102 patients ultimately underwent surgery, yielding a conversion rate of 70.9% and a resection rate of 68.9%. The rate of complete (R0) resection was 100%, with a major pathological response (MPR) of 64.7% and a pathologic complete response (pCR) of 41.2%. Postoperative complications were observed in nine patients (8.8%), and there was no surgery-related mortality within 30 days. The median progression-free survival (PFS) was 19.1 months in the non-surgery group, and the overall survival (OS) was not reached. In the 102 patients who underwent conversion surgery, both the median PFS and OS were not reached, accompanied by 2-year OS and PFS rates of 87.3% and 78.4%, respectively. Our findings showed that neoadjuvant chemoimmunotherapy expanded the opportunities for conversion surgery in potentially resectable cases. Subsequent conversion surgery is safe and has the potential for significant survival benefits.

Molecular imaging using 18F-FDG PET/CT and circulating inflammatory and immune indicators to predict pathological response to neoadjuvant camrelizumab plus chemotherapy in resectable stage IIIA-IIIB NSCLC

OBJECTIVE

This study aims to predict the pathological response of patients with non-small cell lung cancer (NSCLC) in prospective trials of neoadjuvant camrelizumab combined with chemotherapy by integrating the clinical characteristics, PET-associated parameters, and hematological indicators.

METHODS

A prospective analysis was conducted among 24 patients undergoing surgery after neoadjuvant camrelizumab plus chemotherapy. 18F-Fluorodeoxyglucose (FDG) scans were performed before and after neoadjuvant therapy (pre-NAT, post-NAT). Tumor and secondary lymphoid organ metabolic parameters, along with circulating inflammatory and immune indicators, were measured and correlated with pathological response. Receiver operating characteristic (ROC) curve was used to assess biomarkers' predictive accuracy.

RESULTS

Major pathological response (MPR) and pathological complete response (pCR) were achieved in 45.8% (11/24) and 33.3% (8/24) of patients. Before treatment, patients who achieved a pCR had significantly greater SUVmax values (p = 0.011) than non-pCR patients. After treatment, the MPR group exhibited significantly lower SUVmax values than the non-MPR group (p = 0.048). The rate of change in the SUVmax (ΔSUVmax%) differed significantly between the pCR and non-pCR groups (p = 0.019) and between the MPR and non-MPR groups (p = 0.013). After NAT, the lymph nodes' SUVmax in the ypN0 group was significantly lower than that in the ypN + group (p = 0.032). ROC analysis indicated that pre-NAT SUVmax and ΔSUVmax% best distinguished pCR and MPR patients, respectively, with AUCs of 0.82 (p = 0.012) and 0.80 (p = 0.014).

CONCLUSION

Pre-NAT SUVmax, and ΔSUVmax% are promising biomarkers for predicting pathological response to neoadjuvant camrelizumab and chemotherapy.

CLINICALTRIALS

GOV ID

NCT06241807.

Biopsy image-based deep learning for predicting pathologic response to neoadjuvant chemotherapy in patients with NSCLC

Neoadjuvant chemotherapy (NAC) is a widely used therapeutic strategy for patients with resectable non-small cell lung cancer (NSCLC). However, individual responses to NAC vary widely among patients, limiting its effective clinical application. In this study, we propose a weakly supervised deep learning model, DeepDrRVT, which integrates self-supervised feature extraction and attention-based deep multiple instance learning, to improve NAC decision making from pretreatment biopsy images. DeepDrRVT demonstrated superior predictive performance and generalizability, achieving AUCs of 0.954, 0.872 and 0.848 for complete pathologic response, and 0.968, 0.893 and 0.831 for major pathologic response in the training, internal validation and external validation cohorts, respectively. The DeepDrRVT digital assessment of residual viable tumor correlated significantly with the local pathologists' visual assessment (Pearson r = 0.98, 0.80, and 0.59; digital/visual slope = 1.0, 0.8 and 0.55) and was also associated with longer disease-free survival (DFS) in all cohorts (HR = 0.455, 95% CI 0.234-0.887, P = 0.018; HR = 0.347, 95% CI 0.135-0.892, P = 0.021 and HR = 0.446, 95% CI 0.193-1.027, P = 0.051). Furthermore, DeepDrRVT remained an independent prognostic factor for DFS after adjustment for clinicopathologic variables (HR = 0.456, 95% CI 0.227-0.914, P = 0.027; HR = 0.358, 95% CI 0.135-0.949, P = 0.039 and HR = 0.419, 95% CI 0.181-0.974, P = 0.043). Thus, DeepDrRVT holds promise as an accessible and reliable tool for clinicians to make more informed treatment decisions prior to the initiation of NAC.

Neoadjuvant and Adjuvant Osimertinib in Stage IA to IIIA, EGFR-Mutant NSCLC (NORA)

INTRODUCTION

Treatment with adjuvant osimertinib for three years is the standard-of-care for resected stage IB to IIIA NSCLC harboring EGFR mutations. The role of neoadjuvant osimertinib in the perioperative setting is yet to be elucidated in the NeoADAURA study (NCT04351555).

METHODS

This is a single-center, pilot study of patients with clinical stage IA to IIIA NSCLC (American Joint Committee on Cancer eighth edition) harboring an activating EGFR mutation (Exon 19 deletion, L858R) (NCT04816838). Patients were treated with two 28-day cycles of neoadjuvant osimertinib followed by surgical resection and three years of adjuvant osimertinib. The primary endpoint was the objective response rate after two cycles of neoadjuvant treatment. Secondary endpoints included the pathologic complete response rate and major pathologic response rate. Exploratory objectives included the correlation of longitudinal circulating tumor DNA testing (Signatera) and response to neoadjuvant osimertinib.

RESULTS

A total of 25 patients were enrolled and treated with neoadjuvant osimertinib, and all patients received surgical resection with R0 resection. The objective response rate was 44% (n = 11) all of which were partial responses. Fourteen patients (56%) reported stable disease after neoadjuvant osimertinib. The major pathologic response and pathologic complete response rates were 24% (n = 6) and 0%, respectively. None of the patients received adjuvant chemotherapy. The median disease-free survival was not reached at a median follow-up of 31 months (range: 13.8-38.6 mo). Six patients (30%) were circulating tumor DNA-positive at baseline and achieved clearance after 1 cycle of neoadjuvant osimertinib. There were no grade 3 adverse events during neoadjuvant treatment.

CONCLUSIONS

Two cycles of neoadjuvant osimertinib did not meet its primary endpoint of ORR. Neoadjuvant osimertinib is a feasible approach with a manageable safety profile in resectable EGFR-mutant NSCLC.

Survival impact of pathologic features after salvage lung resection following definitive chemoradiotherapy or systemic therapy for initially unresectable lung cancer

PURPOSE

Salvage surgery for primary lung cancer is expected to become increasingly common. This study aimed to clarify the survival impact of pathologic characteristics after salvage surgery.

METHODS

Consecutive patients who underwent salvage surgery following definitive chemoradiotherapy or systemic therapy for initially unresectable lung cancer from 2010 to 2020 were enrolled in this study. The tumor slides were reviewed to determine the size of the tumor bed and the proportions of viable tumor, necrosis, and stroma.

RESULTS

A total of 23 patients were evaluated, and 18 had clinical stage IIIB-IV disease. Six received chemoradiotherapy and 17 received systemic therapy alone. A major pathologic response (MPR, ≤ 10% of viable tumor) was observed in 6 patients, and 4 patients achieved a pathological complete response. The 3-year overall and recurrence-free survival rates (OS and RFS) were 78.6% and 59.2%, respectively. There was no significant difference in OS between patients with and without MPR, and even non-MPR patients achieved a favorable 3-year OS of 70.2%. Meanwhile, patients with high (≥ 30%) stroma showed significantly better OS than those with low (< 30%) stroma (3-year OS: 100% vs. 23.3%, p < 0.001).

CONCLUSIONS

This study showed that the proportion of stroma can be useful for predicting long-term survival after salvage surgery. Further large-scale studies are warranted to confirm the current findings.

Prognostic Significance, Radiological, and Metabolic Characteristics of Metastatic Lymph Nodes in Resectable Non-Small Cell Lung Cancer Following Neoadjuvant Chemoimmunotherapy

BACKGROUND

Metastatic lymph nodes (mLNs) exhibit different responses to neoadjuvant immunotherapy compared to the primary tumor (PT) in non-small cell lung cancer (NSCLC). Evaluating mLNs' response is crucial for predicting treatment efficacy and prognosis; however, such assessments are currently insufficient.

METHODS

We enrolled 101 NSCLC patients with mLNs who underwent neoadjuvant chemoimmunotherapy followed by surgery. Survival outcomes and radiological and metabolic changes were analyzed across different lymph node pathological response groups, and a least absolute shrinkage and selection operator (LASSO) logistic regression model was developed to predict mLNs' response. RNA sequencing was performed to characterize the immune microenvironment of lymph nodes with different pathological responses.

RESULTS

Residual tumors in mLNs were significantly associated with worse recurrence-free survival (p = 0.003) and a trend toward worse overall survival (p = 0.087). Combining the pathological responses of mLNs and PTs improved prognostic stratification. Neither radiological size changes (AUC: 0.621) nor the SUVmax reduction rate (AUC: 0.645) were effective in distinguishing mLNs response. A model combining radiological and metabolic parameters demonstrated fair prediction efficacy (AUC: 0.85). In separate analyses of N1 and N2 nodes, radiological and metabolic changes of N1 mLNs partly reflected their pathologic response (AUC: 0.734; 0.816), unlike in N2 mLNs. RNA sequencing revealed that immune infiltration in responding lymph nodes differed from non-responding ones, with higher CD8+ T cells, NK T cells, B cells, and dendritic cells in the former.

CONCLUSION

The pathological response of mLNs provides additional prognostic information, but current tools are ineffective for detecting residual tumors. A model integrating radiological and metabolic parameters may offer better prediction.

An update on the role of endobronchial ultrasound-guided transbronchial needle aspiration in lung cancer management

INTRODUCTION

Accurate diagnosis and staging are essential for optimizing lung cancer management. The 9th edition of the TNM classification emphasizes distinguishing between single-station and multi-station N2 disease, highlighting the necessity of comprehensive mediastinal node assessment for clinical staging. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive modality used for nodal staging and diagnosis of lung cancer, offering a diagnostic yield comparable to that of mediastinoscopy when performed by experts. Additionally, EBUS-TBNA facilitates essential ancillary testing, including next-generation sequencing (NGS)-based biomarker panels and PD-L1 immunohistochemistry, which are critical for evaluating the suitability of targeted therapies and immune checkpoint inhibitors. Notably, advancements in perioperative management, such as neoadjuvant and adjuvant therapies with immunotherapy and targeted agents, have improved the outcomes of locally advanced diseases. EBUS-TBNA helps identify patients with early-stage lung cancer who are candidates for perioperative therapy.

AREAS COVERED

This review discusses lung cancer diagnosis, nodal staging, the 9th TNM classification, biomarker testing, PD-L1 immunohistochemistry, and precision medicine.

EXPERT OPINION

Lung cancer management requires pathological diagnosis, including histological subtyping, accurate nodal staging of the hilum and mediastinum, and NGS-based biomarker and PD-L1 testing. EBUS-TBNA achieves all three in a single session, making it indispensable in modern lung cancer care.

Intraoperative frozen section diagnosis of lung specimens: An updated review

Intraoperative frozen section (FS) diagnosis is a critical step in the management of patients with pulmonary lesions, which provides guidance for surgical resection procedures. Intraoperative FS diagnosis requires a comprehensive approach that integrates clinical information, imaging findings, and histopathological evaluation. Effective communication between pathologists and surgeons is vital for achieving the best practice result. Intraoperative FS diagnosis faces new challenges in the era of new lung cancer screening strategy, changes in histological tumor classification and addition of new lung tumor entities. Below we discuss the challenges in pre-intraoperative assessment and intraoperative diagnosis of pulmonary nodules. Key considerations include clinical information and CT imaging findings. Multiple nodules require strategic sampling, focusing on the most malignant-appearing lesion. Intraoperative FS diagnosis involves recognizing growth patterns and cellular atypia that help distinction of preinvasive lesions, minimal invasive, and invasive tumor although it might be challenging. Distinguishing benign from malignant tumors is also discussed, with emphasis on histological and imaging features. Special considerations include spread through air spaces (STAS), margin assessment, lymphoproliferative disorders, infectious diseases, and benign or uncertain-behavior tumors.

Safety and necessity of omitting mediastinal lymph node dissection in cN0/N1 non-small cell lung cancer after neoadjuvant immunotherapy

Background

Lymph nodes are crucial for perioperative immunotherapy but have to be completely resected in surgery. Trials evaluating the safety and necessity of omitting systemic mediastinal lymph node (mLN) dissection in non-small cell lung cancer (NSCLC) are still absent.

Methods

cN0/N1 NSCLC patients who received neoadjuvant immunotherapy and radical surgery were retrospectively collected from three institutions. Restricted cubic spline regression and receiver operating characteristic curve were used to analyze the association between mLN dissection number and survival outcomes. Confounding factors between selective and systemic mLN dissection groups were adjusted by inverse probability of treatment weighting (IPTW). The characteristics of memory CD8+ T cells in immunotherapy-treated mLN were identified by single-cell RNA and T-cell receptor sequencing (scRNA/TCR-seq) data retrieved from GSE185206.

Results

From 2019 to 2021, 131 neoadjuvant-treated cN0/N1 NSCLC patients were collected. The mLN clearance rate was 98.5% in the whole cohort and 100% in patients with radiologically confirmed complete response. Resected lymph node counts were irrelevant with local recurrence, distant metastasis, or death. Compared with selective mLN dissection, systemic mLN dissection did not show any survival benefit but showed slightly higher postoperative recurrence risk in both unadjusted and IPTW-adjusted cohorts. scRNA/TCR-seq showed that stem-like exhausted CD8+ memory T cells were the progenitors of tumor-specific CD8+ T lymphocytes in primary tumors and were abundantly enriched in resected mLN.

Conclusions

Omitting systemic mLN dissection was safe in cN0/N1 NSCLC patients who received neoadjuvant immunotherapy. Excessive mLN dissection may disrupt the repertoire of stem-like exhausted CD8+ memory T cells and consequently impair the efficacy of adjuvant immunotherapy.

Predictive value of baseline CT imaging features combined with serum biomarkers for neoadjuvant chemotherapy response in adenocarcinoma of the gastroesophageal junction

BACKGROUND

Gastroesophageal junction (GEJ) adenocarcinoma, located at the esophagus-stomach junction, poses significant clinical challenges due to its complex physiological structure. Neoadjuvant chemotherapy (NAC) is standard for tumor downstaging, but response variability necessitates reliable predictive markers. This study evaluates baseline computed tomography (CT) imaging parameters and serum markers as predictors for chemotherapy response in GEJ adenocarcinoma.

METHODS

A retrospective study included 304 GEJ adenocarcinoma patients treated with the SOX regimen (S-1 + Oxaliplatin) between January 2020 and December 2024. Patients were categorized based on Tumor Regression Grade (TRG) into effective (TRG 0-1) and poor response (TRG 2-3) groups. Baseline CT characteristics were assessed alongside serum markers, including carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP), carbohydrate antigen 19-9 (CA 19-9), and carbohydrate antigen 72-4 (CA 72-4). Multivariate logistic regression identified independent predictors, and a combined predictive model was developed and validated using an external cohort.

RESULTS

The effective treatment group showed significantly lower serum markers (CEA, AFP, CA 19-9, CA 72-4) and distinct CT parameters, including decreased maximum tumor thickness and area, and lower CT enhancement values. Extramural vascular invasion (EMVI) and tumor surface ulceration were associated with poor response. The combined predictive model demonstrated high accuracy, with an area under the curve (AUC) of 0.813 in the training set and 0.846 in the validation cohort.

CONCLUSION

Baseline CT characteristics, when combined with serum markers, effectively predict NAC response in GEJ adenocarcinoma.

Semi-synthesis and biological activities of heterocyclic compounds containing camphor

Breast cancer and lung cancer are two of the most prevalent and deadly malignancies worldwide. Both cancers present significant challenges in terms of effective treatment and management, highlighting the urgent need for novel therapeutic strategies that can improve patient outcomes. This study focuses on the synthesis of novel heterocyclic compounds derived from the naturally formed camphor, aimed at evaluating their cytotoxicity. The research addresses the need for effective cancer treatments by presenting compounds that demonstrate significant inhibitory effects against MCF-7 breast carcinoma cells. Among these, compound 20 exhibited remarkable potency, with an IC50 value of 0.78 μM, surpassing the efficacy of standard chemotherapeutics, dasatinib (IC50 = 7.99 μM) and doxorubicin (IC50 = 3.10 μM). In the context of A549 lung cancer cells, compound 20 also showed strong inhibitory activity (IC50 = 1.69 μM), again outperforming dasatinib (IC50 = 11.8 μM) and doxorubicin (IC50 = 2.43 μM). To further elucidate the biological activities of these compounds, molecular docking studies were performed, revealing that compound 20 exhibited the highest binding energy among the tested compounds, supporting the experimental findings. These results indicate that the synthesized camphor-derived heterocycles, particularly compound 20, have significant potential as potent anticancer agents against breast and lung cancer cell lines.

Surgery for Pancoast Tumors in Multimodality Setting: Analysis of Outcomes and Risk Factors

Background: Pancoast tumors are a rare subset of lung cancers that require a multimodal approach (induction chemoradiotherapy and surgery), best performed in highly specialized centers. This study analyzes the outcomes and prognostic factors in patients treated at a high-volume center over an extended period. Methods: We retrospectively reviewed 43 patients who underwent surgery for Pancoast tumors, following induction treatment between 2005 and 2023. Survival was estimated using the Kaplan-Meier method, and a Cox proportional hazards model was applied to identify prognostic factors (significance level p = 0.05). Results: The median patient age was 63 years, with over 90% having a disease at stage III or higher. Induction chemoradiotherapy was administered to 79% of the patients, achieving a pathological complete response (PCR) in 23% of the patients. The median overall survival (OS) was 37 months, with 1-3 and 5-year OS rates of 71%, 52%, and 41%, respectively. The median disease-free survival (DFS) was 38 months, with 1-, 3-, and 5-year DFS rates of 72%, 62%, and 35%, respectively. A pathological complete response (PCR) and vertebral and/or vascular infiltration significantly influenced recurrence and mortality risk. Conclusions: Trimodal therapy still offers the best short- and long-term outcomes in patients with Pancoast tumors. Future strategies incorporating tyrosine kinase inhibitors and anti-PD1/PD-L1 may improve outcomes for patients by increasing PCR rates and improving disease control.

The Lung Cancer Immune Prognostic Score predicts pathologic complete response and survival in NSCLC patients receiving neoadjuvant immunochemotherapy

Introduction

Neoadjuvant immunochemotherapy (nICT) has significantly improved event-free survival (EFS) and pathologic complete response (pCR) in patients with resectable non-small cell lung cancer (NSCLC). However, the lack of validated biomarkers limits their ability to predict therapeutic efficacy and survival outcomes. This study aimed to develop a novel inflammatory and nutritional index, the Lung Cancer Immune Prognostic Score (LCIPS), to predict pCR and survival prognosis in patients with NSCLC.

Methods

This retrospective study included 131 patients with clinical stage IB-IIIB NSCLC who underwent neoadjuvant immunochemotherapy between May 2020 and May 2024. Baseline clinical data and hematological parameters were collected. Lasso regression analysis was employed to identify hematological indices associated with pCR, and the LCIPS was constructed based on these factors. Kaplan-Meier survival analysis and log-rank tests were used to assess survival differences. Logistic regression was performed to identify the predictors of pCR, while Cox regression analysis determined independent prognostic factors for disease-free survival (DFS) and overall survival (OS). The predictive performance of the LCIPS was validated using a nomogram.

Results

Lasso regression identified three core hematological indices: the albumin-to-globulin ratio (A/G), absolute monocyte count (MONO), and absolute lymphocyte count (LYM). The LCIPS formula was as follows: LCIPS=0.900×A/G+0.761×MONO (109/L) -0.065×LYM (109/L). Receiver operating characteristic (ROC) curve analysis showed that the LCIPS had superior predictive efficacy (area under the curve (AUC) = 0.68) compared to other classical markers. Univariate and multivariate logistic regression analyses identified intraoperative lymph node dissection status and A/G and LCIPS as independent predictors of pCR (p < 0.05). Multivariate Cox regression analysis demonstrated that smoking status and LCIPS were independent prognostic factors for DFS and OS. Nomogram validation indicated robust predictive accuracy for LCIPS. Notably, among immune-related adverse events (irAEs), endocrine- and cardiac-related irAEs significantly affected DFS (p < 0.05).

Discussion

LCIPS is an independent predictor of pCR in patients with NSCLC receiving neoadjuvant immunochemotherapy and is associated with improved DFS and survival outcomes. This novel index offers valuable guidance for personalized treatment strategies.

Prospects for the application of pathological response rate in neoadjuvant therapy for gastric cancer

With the annual increase in the incidence and mortality rates of gastric cancer, it has gradually become one of the significant threats to human health. Approximately 90% of gastric cancer patients are diagnosed with adenocarcinoma. Although the 5-year survival rate for early-stage gastric cancer can exceed 90%, due to its concealed symptoms, less than half of the patients are eligible for radical surgical treatment upon diagnosis. For gastric cancer patients receiving palliative treatment, the current expected survival time is only about one year. In China, the majority of gastric cancer patients, accounting for about 80% of the total, are in the locally advanced stage. For these patients, radical surgery remains the primary treatment option; however, surgery alone is often inadequate in controlling tumor progression. In the pivotal MAGIC study, the recurrence rate was as high as 75%, and similar results were obtained in the French ACCORD07-FFCD9703 study. Numerous clinical trials are currently exploring preoperative neoadjuvant therapy for patients with locally advanced gastric cancer. Data indicates that preoperative neoadjuvant therapy can not only reduce the size of the local tumor but also shrink surrounding lymph nodes, thereby downstaging the tumor and improving the R0 resection rate. Additionally, it can decrease tumor cell activity and eliminate potential micrometastases. The emergence of various immunotherapies has ushered in a new era for neoadjuvant treatment options for gastric cancer.

Neoadjuvant Concurrent Chemo-Immuno-Radiation Therapy Followed by Surgery and Adjuvant Immunotherapy for Resectable Stage III N2 NSCLC: Primary Results From the SQUAT Trial (WJOG 12119L)

INTRODUCTION

Neoadjuvant chemo-immunotherapy is one of the standard treatment options for resectable stage II to III NSCLC. Nevertheless, this treatment yielded insufficient local control in the CheckMate 816 trial. We hypothesized that adding radiotherapy could improve local control, thereby improving survival outcomes.

METHODS

Eligible patients had clinical T1 to T3 or T4 (tumor size) N2 stage IIIA to B NSCLC (American Joint Committee on Cancer version 8), pathologically confirmed as N2 without extranodal invasion. Patients received concurrent chemoradiotherapy (carboplatin [area under the curve = 2] and paclitaxel [40 mg/m2] on days 1, 8, 15, 22, and 29, with 50 Gy radiation over 25 d) and durvalumab (1500 mg) on days 1 and 29, followed by surgical resection within two to six weeks. After surgery, durvalumab adjuvant therapy was administered for up to one year. The primary endpoint was major pathologic response (MPR: ≤10% viable tumor), with secondary endpoints being pathologic complete response, progression-free survival (PFS), overall survival (OS), and safety.

RESULTS

From January 2020 through February 2022, 31 patients were enrolled from 10 Japanese institutions. The MPR rate was 63% (90% confidence interval: 47%-78%), which met the primary endpoint, and the pathologic complete response rate was 23%. At a median follow-up of 28 months, the two-year PFS and OS rates were 43% and 76%, respectively. Grade 3 or 4 adverse events occurred in 48% of cases, including one treatment-related death.

CONCLUSIONS

Compared with recently published results of peri-operative chemo-immunotherapy trials, this treatment regimen had a higher MPR rate. Nevertheless, this benefit did not necessarily translate into improved PFS or OS.

Data set for the reporting of lung cancer: recommendations from the International Collaboration on Cancer Reporting (ICCR)

Lung cancer is the leading cause of cancer related deaths worldwide, although some patients with early-stage disease can be cured with surgical resection. Standardised reporting of all clinically relevant pathological parameters is essential for best patient care and is also important for ongoing data collection and refinement of important pathological features that impact patient prognosis, staging and clinical care. Using the established International Collaboration on Cancer Reporting (ICCR) procedure, a representative international expert panel of nine lung pathologists as well as an oncologist was convened. Essential core elements and suggested non-core elements were identified for inclusion in the resected lung cancer pathology data set based on predetermined levels of evidence as well as consensus expert opinion. A lung cancer histopathology reporting guide was developed that includes relevant clinical, macroscopic, microscopic and ancillary testing. Critical review and discussion of current evidence was incorporated into the new data set including changes from the 2021 World Health Organisation (WHO) Classification of Thoracic Tumours, fifth edition, new requirements for grading invasive non-mucinous adenocarcinomas, assessment of response to neoadjuvant therapy and requirements for molecular testing in early-stage resected lung carcinomas. This ICCR data set represents incorporation of all relevant parameters for histology reporting of lung cancer resection specimens. Routine use of this data set is recommended for all pathology reporting of resected lung cancer and it is freely available worldwide on the ICCR website (https://www.iccr-cancer.org/datasets/published-datasets/). Widespread implementation will help to ensure consistent and comprehensive pathology reporting and data collection essential for lung cancer patient care, clinical trials and other research.

Evaluation of ImmunoPET in the efficacy and prognosis of immunotherapy for lung cancer

Advances in immune oncology have established immunotherapy as the first-line standard treatment for lung cancer; however, its efficacy remains limited to a subset of patients. Developing predictive biomarkers within the tumor microenvironment (TME) to assess the efficacy and prognosis of immunotherapy can enhance drug development and treatment strategies. Immuno-positron emission tomography (ImmunoPET) non-invasively visualizes the biological distribution of key targets in the TME using highly specific, radiolabeled tracers. PET imaging of the TME can serve as a reliable biomarker for predicting and monitoring responses to immune therapy, complementing existing immunohistochemical techniques. This review will focus on the development of ImmunoPET biomarkers, as well as the application of corresponding tracers and radionuclides in lung cancer. We will focus on available clinical tracers and those under development, outlining each TME target and its clinical validation for tumor immunotherapy efficacy and prognosis, while discussing the latest advances that may enhance ImmunoPET in future.

Association of cardiovascular disease and CIRS‑G and ACE‑27 comorbidity indices with pathological complete response of non‑small cell lung cancer to neoadjuvant chemoimmunotherapy

Neoadjuvant chemoimmunotherapy (NCIO) is a new and effective treatment for cancer, but its efficacy in treating certain patients is unclear. We previously found that comorbidity was an independent factor associated with the pathological complete response (pCR) of non-small cell lung cancer (NSCLC) to NCIO. However, we did not address which comorbidities or comorbidity indices were associated with pCR. The present study retrospectively collected the data for NSCLC patients who underwent NCIO after surgery at The Second Xiangya Hospital of Central South University (Hunan, China) between January 2019 and July 2022. The associations between comorbidities/comorbidity indices and pCR rates/clinicopathological factors were analyzed. In total, 101 eligible patients with stage IIB-IIIC NSCLC were enrolled. Comorbid hypertension [odds ratio (OR)=0.321(0.110-0.937)], vascular disease [OR=0.275 (0.111-0.677)] and cardiovascular disease [OR=0.272 (0.114-0.646)] were all significantly associated with pCR (all P<0.05). The comorbidity indices Cumulative Illness Rating Scale-Geriatric (CIRS-G) ≥2 [OR=0.360 (0.154-0.840)], CIRS-G ≥3 [OR=0.404 (0.179-0.912)], CIRS-G ≥4 [OR=0.293 (0.105-0.817)] and Adult Comorbidity Evaluation-27 (ACE-27) ≥2 [OR=0.427 (0.192-0.950)] were all significantly associated with pCR (all P<0.05). Cardiovascular disease was the only independent risk factor for pCR [adjusted OR=0.272 (0.114-0.646); P=0.003] according to multivariate logistic analysis. In conclusion, cardiovascular comorbidities and the CIRS-G and ACE-27 indices were associated with the effectiveness of NCIO and clinicopathological factors. These results could help to screen for the most suitable NSCLC patients for NCIO.

The Impact of the Tumor Microenvironment on the Effect of IL-1β Blockade in NSCLC: Biomarker Analyses from CANOPY-1 and CANOPY-N Trials

SIGNIFICANCE

Patients with NSCLC with immunosuppressive tumor features and low T-cell infiltration derive less benefit from ICI-based treatment. Biomarker analyses presented here suggest that these patients may benefit from the addition of anti-IL-1β therapy to their treatment.

Comprehensive MALDI mass spectrometry imaging of tumor regions post-neoadjuvant therapy

The spatial metabolic analysis of tumor tissues following neoadjuvant chemotherapy (NAC) is critical for understanding chemotherapy-induced metabolic changes. Matrix-assisted laser desorption/ionization mass spectrometry imaging (MALDI MSI) offers a powerful tool for revealing spatially resolved metabolic profiles within tissues. However, necrotic regions in post-NAC tissues are fragile, creating challenges for sample preparation and MALDI MSI analysis. In this study, we introduce an optimized workflow employing conductive tape to stabilize tissue samples during sectioning and MALDI MSI analysis, preserving necrotic areas while maintaining tissue integrity. Using this technique, we successfully mapped metabolic alterations across necrotic and viable regions of post-NAC tumor tissues, providing new insights into metabolic changes that occur after chemotherapy. Our findings establish MALDI MSI as a valuable tool for spatially resolved metabolomics in post-NAC tumor tissues, offering insights into chemotherapy-induced metabolic changes.

ATF3 Within the Interferon Signaling Pathway: A Potential Biomarker for Predicting Pathological Response to Neoadjuvant Chemoimmunotherapy

BACKGROUND

Neoadjuvant chemoimmunotherapy has achieved high downstaging and pathologic response rates in nonsmall-cell lung cancer (NSCLC), but outcomes vary significantly. Early identification of beneficiaries remains a challenge.

METHODS

This study analyzed baseline transcriptomic data from 24 NSCLC patients (9 major pathological response [MPR], 15 nonmajor pathological response [NMPR]) treated with neoadjuvant chemoimmunotherapy, sourced from the GEO database. Molecular analyses and immune infiltration analyses were performed using pathologic response as an endpoint. After identifying the interferon signaling subset NeoIGS, we analyzed the relationship between NeoIGS and immune scores, immune cell infiltration, and immunotherapy efficacy. A key gene in NeoIGS was screened by reveiver operating characteristic curve (ROC) analysis. Subsequently, the expression of the key gene was assessed by immunohistochemistry in 53 NSCLC patients receiving neoadjuvant chemoimmunotherapy.

RESULTS

Interferon signaling pathway expression and CD8+ T-cell infiltration were higher in the MPR group. NeoIGS predicted pathological response to neoadjuvant chemoimmunotherapy (AUC = 0.926) and also demonstrated predictive value in the ICIs monotherapy cohort. IPS and TIDE scores also confirmed NeoIGS's association with immunotherapy in the TCGA NSCLC dataset. Furthermore, patients with higher NeoIGS scores had more immune cell infiltration and increased expression of ICI targets. ROC analysis identified ATF3 as NeoIGS's key gene. In the clinical cohort, ATF3 outperformed PD-L1 in predicting pathologic response, with a 90.0% MPR rate in the high-expression group.

CONCLUSION

We established that a subset of interferon signaling pathways, NeoIGS, is closely associated with immunotherapy. Among them, ATF3 is the most critical gene that accurately predicts pathological remission in neoadjuvant chemoimmunotherapy.

Neoadjuvant and Adjuvant Immune-based Approach for Renal Cell Carcinoma: Pros, Cons, and Future Directions

CONTEXT

Immune-oncology strategies are revolutionising the perioperative treatment in several tumour types. The perioperative setting of renal cell carcinoma (RCC) is an evolving field, and the advent of immunotherapy is producing significant advances.

OBJECTIVE

To critically review the potential pros and cons of adjuvant and neoadjuvant immune-based therapeutic strategies in RCC, and to provide insights for future research in this field.

EVIDENCE ACQUISITION

We performed a collaborative narrative review of the existing literature.

EVIDENCE SYNTHESIS

Adjuvant immunotherapy with pembrolizumab is a new standard of care for patients at a higher risk of recurrence after nephrectomy, demonstrating a disease-free survival and overall survival benefit in the phase 3 KEYNOTE-564 trial. Current data do not support neoadjuvant therapy use outside clinical trials. While both adjuvant and neoadjuvant immune-based approaches are driven by robust biological rationale, neoadjuvant immunotherapy may enable a stronger and more durable antitumour immune response. If neoadjuvant single-agent immune checkpoint inhibitors demonstrated limited activity on the primary tumour, immune-based combinations may show increased activity. Overtreatment and a risk of relevant toxicity for patients who are cured by surgery alone are common concerns for both neoadjuvant and adjuvant strategies. Biomarkers helping patient selection and treatment deintensification are lacking in RCC. No results from randomised trials comparing neoadjuvant or perioperative immune-based therapy with adjuvant immunotherapy are available.

CONCLUSIONS

Adjuvant immunotherapy is a new standard of care in RCC. Both neoadjuvant and adjuvant immunotherapy strategies have potential advantages and disadvantages. Optimising perioperative treatment strategies is nuanced, with the role of neoadjuvant immune-based therapies yet to be defined. Given strong biological rationale for a pre/perioperative approach, there is a need for prospective clinical trials to determine clinical efficacy. Research investigating biomarkers aiding patient selection and treatment deintensification strategies is needed.

PATIENT SUMMARY

Immunotherapy is transforming the treatment of kidney cancer. In this review, we looked at the studies investigating immunotherapy strategies before and/or after surgery for patients with kidney cancer to assess potential pros and cons. We concluded that both neoadjuvant and adjuvant immunotherapy strategies may have potential advantages and disadvantages. While immunotherapy administered after surgery is already a standard of care, immunotherapy before surgery should be better investigated in future studies. Future trials should also focus on the selection of patients in order to spare toxicity for patients who will be cured by surgery alone.

Histological Assessment and Interobserver Agreement in Major Pathologic Response for Non-Small Cell Lung Cancer with Neoadjuvant Therapy

PURPOSE

Major pathologic response (MPR), defined as ≤ 10% of residual viable tumor (VT), is a prognostic factor in non-small cell lung cancer (NSCLC) after neoadjuvant therapy. This study evaluated interobserver reproducibility in assessing MPR, compared area-weighted and unweighted VT (%) calculation, and determined optimal VT (%) cutoffs across histologic subtypes for survival prediction.

MATERIALS AND METHODS

This retrospective study included 108 patients with NSCLC who underwent surgical resection after neoadjuvant chemotherapy or chemoradiation at Seoul National University Bundang Hospital between 2009-2018. Three observers with varying expertise independently assessed tumor bed and VT (%) based on digital whole-slide images.

RESULTS

Reproducibility in tumor bed delineation was reduced in squamous cell carcinoma (SqCC) with smaller tumor bed, although overall concordance was high (Dice coefficient, 0.96; intersection-over-union score, 0.92). Excellent agreement was achieved for VT (%) (intraclass correlation coefficient=0.959) and MPR using 10% cutoff (Fleiss' kappa=0.911). Shifting between area-weighted and unweighted VT (%) showed only one case differing in MPR status out of 81 cases. The optimal cutoff was 10% for both adenocarcinoma (ADC) and SqCC. MPR+ was observed in 18 patients (17%), with SqCC showing higher MPR+ rates (p=0.044), lower VT (%) (p < 0.001), and better event-free survival (p=0.015) than ADC. MPR+ significantly improved overall survival (p=0.023), event-free survival (p=0.001), and lung cancer-specific survival (p=0.012).

CONCLUSION

While MPR assessment demonstrated robust reproducibility with minimal impact from the tumor bed, attention is warranted when evaluating smaller tumor beds in SqCC. A 10% cutoff reliably predicted survival across histologic subtypes with higher interobserver reproducibility.

Neoadjuvant Therapy and Lung Cancer: Role of Pathologists

CONTEXT.—

Recent neoadjuvant clinical trials in lung cancer have demonstrated the survival benefits in carefully selected patients. Standardization of the assessment of pathologic response to neoadjuvant therapy in surgically resected specimens is required.

OBJECTIVE.—

To review the current pathology practices in the gross processing and microscopic assessment of surgically resected non-small cell lung carcinoma specimens after neoadjuvant therapy.

DATA SOURCES.—

PubMed publications and experience of the author.

CONCLUSIONS.—

Gross processing of the surgically resected lung carcinoma after neoadjuvant therapy needs further refinement and standardization in clinical trials and in a real-world clinical practice. Microscopic assessment of the response includes quantification of viable tumor, necrosis, and stroma. The best approach would be to use a single standardized and most reproducible scoring system. Published studies on gross processing of lung carcinoma specimens in the neoadjuvant setting and microscopic assessment of pathologic response provide a good foundation for the future standardization of pathology practice.

NeoTRACK trial: Neoadjuvant TiRagolumab, Atezolizumab and Chemotherapy - dissection of IO- efficacy in NSCLC by longitudinal tracKing - protocol of a non-randomised, open-label, single-arm, phase II study

BACKGROUND

Immunotherapies targeting the programmed death receptor-1/programmed death ligand-1(PD-1/PD-L1) checkpoint have a major impact on the treatment of both resectable and advanced non-small cell lung cancer (NSCLC). Additional blockade of the T-cell immunoreceptor with immunoglobulin and immunoreceptor tyrosine-based inhibition motif domain (TIGIT)-receptor may synergistically foster the immune-related response. Several trials are currently investigating the combination of neoadjuvant platinum-based chemotherapy and dual checkpoint inhibition prior to curative surgery. The investigator-initiated NeoTRACK trial (EU CT number: 2022-501322-38-00; ClinicalTrials.gov identifier: NCT05825625; IKF056) aims to evaluate the feasibility and safety of perioperative anti-PD-L1 (by atezolizumab) and anti-TIGIT (by tiragolumab) treatment in combination with chemotherapy in patients with early stage NSCLC.

METHODS AND ANALYSIS

NeoTRACK is an open-label, single-arm, prospective, bicentric phase II trial. Patients with NSCLC in clinical stages II, IIIA and IIIB (only T3N2) will receive two cycles of standard platinum-based chemotherapy in combination with the anti-TIGIT antibody tiragolumab and the anti-PD-L1 antibody atezolizumab, followed by curative surgery. After surgery, patients without pathological complete response (pCR) will receive another two cycles of chemotherapy in combination with tiragolumab and atezolizumab, followed by tiragolumab/atezolizumab maintenance for up to 1 year (maximum 16 cycles). Patients with pCR will only receive dual immunotherapy. All patients will be followed-up for 30 months after the last study treatment. The clinical study will be aligned with a translational research programme to investigate treatment-naïve tumour tissues, surgical specimens and longitudinally collected blood samples. 35 patients are planned for enrolment. Patient recruitment started in August 2023, and treatment of the last patient is estimated to start 2.5 years thereafter.

DISCUSSION

The NeoTRACK trial aims to assess the feasibility and efficacy of combining tiragolumab and atezolizumab as both neoadjuvant and adjuvant therapies in patients with resectable NSCLC. The concept of treatment personalisation based on postoperative pCR is of great clinical interest.

ETHICS AND DISSEMINATION

The trial obtained ethical and regulatory approval in Germany through the Clinical Trials Information System (CTIS, ID: 2022-501322-38-00) and the Paul Ehrlich Institute (PEI, competent authority for approval of clinical trials using medicinal products for human use in Germany, process number: PB00148) on 30 March 2023. A data safety and monitoring board will meet regularly to review ongoing treatment in terms of safety.Study results will be published in peer-reviewed journals, presented at conferences and in the public registry of CTIS, following trial completion.

TRIAL REGISTRATION NUMBER

NCT05825625.

Current Biomarkers in Non-Small Cell Lung Cancer-The Molecular Pathologist's Perspective

Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related mortality worldwide. Advances in tissue-based biomarkers have significantly enhanced diagnostic and therapeutic approaches in NSCLC, enabling precision medicine strategies. This review provides a comprehensive analysis of the molecular pathologist's practical approach to assessing NSCLC biomarkers across various specimen types (liquid biopsy, broncho-alveolar lavage, transbronchial biopsy/endobronchial ultrasound-guided biopsy, and surgical specimen), including challenges such as biological heterogeneity and preanalytical variability. We discuss the role of programmed death ligand 1 (PD-L1) immunohistochemistry in predicting immunotherapy response, the practice of histopathological tumor regression grading after neoadjuvant chemoimmunotherapy, and the application of DNA- and RNA-based techniques for detecting actionable molecular alterations. Finally, we emphasize the critical need for quality management to ensure the reliability and reproducibility of biomarker testing in NSCLC.

Safety and Efficacy of Salvage Surgery after Treatment With Immune-Checkpoint Adjuvant Inhibitors for Advanced Non-Small Cell Lung Cancer: A Multicentric Study

OBJECTIVE

In advanced non-small cell lung cancer (NSCLC), immune-checkpoint inhibitors (ICIs) can achieve significant clinical responses. This raises the question of whether to consider salvage surgery as a curative treatment option. Few case series reported encouraging results in terms of pathological response. However, intraoperative risk and postoperative morbidity have been highlighted. This study aims to assess the safety and feasibility of surgery after ICIs administration and to evaluate its effectiveness on the final pathological examination.

METHODS

We retrospectively identified stages III-IVA NSCLC consecutive patients who underwent surgery with radical intent after ICIs at three National Centers (2016-2022). Before treatment, all patients were considered unresectable by a multidisciplinary discussion. After surgery, pathological response was evaluated according to the International Association for the Study of Lung Cancer (IASLC) recommendation.

RESULTS

Thirty-one patients were included; pretreatment clinical stage was: IIIA in 4 patients (10%), IIIB in 13 (42%), IIIC in 3 (13%), and IVA in 11 (35%). Median treatment duration was four cycles. Only anatomical resections were performed, with lobectomy that represent the main type of resection (22 patients, 74%). A minimally invasive approach was performed in 10 patients (32%), with a conversion rate of 0%. Postoperative complications were observed in eight patients (25%). Complete pathologic response (CPR) and major pathologic response (MPR) were 48% and 16%, respectively. Two and 3-years survival were 88%.

CONCLUSIONS

Based on our experience, salvage surgery of advanced NSCLC treated with ICIs confirm his feasibility and safety in responder patients. Moreover, it is associated with low morbidity, high CPR rate, and satisfying medium-term survival.

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

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.

Spread through air spaces may predict early progression after salvage surgery for EGFR-mutant advanced lung adenocarcinoma treated with targeted therapy

OBJECTIVE

Salvage resection for residual lung cancer harboring epidermal growth factor receptor (EGFR) mutations following EGFR-tyrosine kinase inhibitor (TKI) treatment is gaining traction for its survival benefits. However, the impact of pathological factors on survival remains unclear.

METHODS

Between 2013 and 2023, we retrospectively reviewed 34 patients with advanced lung adenocarcinoma who received EGFR-TKI therapy. After a median TKI treatment duration of 9.1 months, all patients demonstrated either partial response (n = 27) or stable disease (n = 7) before salvage surgery. Demographic, pathological outcomes, progression-free survival (PFS), and overall survival (OS) were analyzed.

RESULTS

Among the 34 patients, six (17.6%) achieved a pathological complete response (pCR) and nine (26.5%) had a major pathological response (MPR). Additionally, 11 patients (32.4%) exhibited spread through air spaces (STAS), and lymphovascular invasion (LVI) was observed in nine patients (26.5%). The 3-year PFS and OS rates were 55.8% and 60.5%, respectively. No significant differences in PFS or OS were observed regarding mutation type, TKI generation, pCR, MPR, or LVI. However, Kaplan-Meier analysis revealed that STAS was associated with shorter PFS compared to non-STAS cases (p = 0.01). In multivariate analysis, STAS was identified as an independent prognostic factor for PFS (hazard ratio: 2.83, 95% CI: 1.35-28.54, p = 0.02). No significant prognosticators were found for OS in univariate or multivariate analyses.

CONCLUSION

While salvage surgery following TKI treatment is feasible and prolongs survival by removing residual primary tumor with potential TKI resistance, STAS may contribute to a higher risk of early progression. This finding warrants further investigation and tailored treatment strategies.

Anti-PD1 based precision induction therapy in unresectable stage III non-small cell lung cancer: a phase II umbrella clinical trial

The efficacy and safety of induction-immunotherapy followed by surgery for unresectable Stage III non-small cell lung cancer (NSCLC) remain challenging. In this open-label, single-center, phase II clinical umbrella trial (ChiCTR2000035367), 100 unresectable Stage III NSCLC patients are enrolled. Patients with PD-L1 expression ≥ 50% but contraindications to anti-angiogenic therapy receive immuno-monotherapy. Patients with PD-L1 expression ≥ 1% and no contraindications to anti-angiogenic therapy receive immunotherapy plus anti-angiogenesis therapy. Patients with PD-L1 expression between 1% and 49%, contraindications to anti-angiogenic therapy, or negative/unknown PD-L1 expression receive chemoimmunotherapy. The primary endpoint is the major pathological response (MPR) rate. Among 47 surgically-treated patients, the MPR rate is 61.7% (95% confidence interval [CI]: 46.4%-75.5%), achieving the prespecified endpoint. For secondary endpoints, the objective response rate for all patients is 54.0% (95% CI: 43.7-64.0). The median event-free survival is 29.9 months (95% CI: 17.0-42.7). Most common adverse event is anemia (49.0%). Exploratory transcriptomic analyses reveal Bone Marrow Stromal Cell Antigen 1 (BST1) as a promising biomarker for response to chemoimmunotherapy. Generally, for unresectable stage III NSCLC patients, anti-PD1 based induction-therapy according to PD-L1 expression and contraindication to antiangiogenic therapy followed by surgery is a feasible option.

Bibliometric analysis of targeted immunotherapy for osteosarcoma-current knowledge, hotspots and future perspectives

Objective

The objective of this study is to conduct a bibliometric analysis on examining the current condition, areas of interest, and rising trends of immunotherapy for osteosarcoma (ITFOS), as well as its importance in associated research domains.

Methods

An extensive collection of academic papers on the use of ITFOS was obtained from the Web of Science between January 1, 2000 and October 20, 2023. Then, using a variety of tools like HisCite, VOSviewer, CiteSpace, and the bibliometrix package, a bibliometric study was carried out. This study included the collection of information on country, institution, author, journal, and keywords.

Results

A comprehensive analysis was undertaken on a total of 616 publications obtained from 247 journals, encompassing the contributions of 3725 authors affiliated with 831 institutes spanning across 43 countries/regions. Notably, China exhibited the highest quantity of published 277 (44.99%) articles on ITFOS. The most productive institution was Zhejiang University, with 26 (4.22%) publications. The author with the highest publication output was Tsukahara, Tomohide from Japan with 15 (2.44%) publications. The article with the most citation was "DOI: 10.1200/JCO.2014.58.0225". Frontiers in Immunology demonstrated the highest level of productivity, having published a total of 31 (5.03%) articles. The most frequently used were "osteosarcoma," "immunotherapy," and "cancer,". Meanwhile, "sequencing", "prognostic signature" and "immune microenvironment" have been identified as the research frontiers for the forthcoming years.

Conclusion

This paper provides a thorough evaluation of current research trends and advancements in ITFOS. It includes relevant research findings and emphasizes collaborative efforts among authors, institutions, and countries.

Is pathological response an adequate surrogate marker for survival in neoadjuvant therapy with immune checkpoint inhibitors?

Pathological response (PR) is an oncological outcome measure that indicates the therapeutic response to neoadjuvant therapy. In clinical trials involving neoadjuvant or perioperative interventions, overall survival and disease/event-free survival are typically the primary outcome measures. Although some evidence suggests that pathological complete response (pCR) can serve as a surrogate marker for the primary endpoint in prospective trials, it remains uncertain whether pCR is a true surrogate marker for patients with cancer undergoing curative resection across all solid tumours. Here, we review the role of PR as a surrogate marker and its associated methodological issues in the era of perioperative immune checkpoint inhibitors.

Artificial intelligence for diagnosis and predictive biomarkers in Non-Small cell lung cancer Patients: New promises but also new hurdles for the pathologist

The rapid development of artificial intelligence (AI) based tools in pathology laboratories has brought forward unlimited opportunities for pathologists. Promising AI applications used for accomplishing diagnostic, prognostic and predictive tasks are being developed at a high pace. This is notably true in thoracic oncology, given the significant and rapid therapeutic progress made recently for lung cancer patients. Advances have been based on drugs targeting molecular alterations, immunotherapies, and, more recently antibody-drug conjugates which are soon to be introduced. For over a decade, many proof-of-concept studies have explored the use of AI algorithms in thoracic oncology to improve lung cancer patient care. However, despite the enthusiasm in this domain, the set-up and use of AI algorithms in daily practice of thoracic pathologists has not been operative until now, due to several constraints. The purpose of this review is to describe the potential but also the current barriers of AI applications in routine thoracic pathology for non-small cell lung cancer patient care and to suggest practical solutions for rapid future implementation.

Asian Thoracic Oncology Research Group expert consensus statement on the peri-operative management of non-small cell lung cancer

The peri-operative management of non-small cell lung cancer (NSCLC) in earlier stage disease has seen significant advances in recent years with the incorporation of immune checkpoint inhibitors and targeted therapy. However, many unanswered questions and challenges remain, including the application of clinical trial data to routine clinical practice. Recognising the unique demographic profile of Asian patients with NSCLC and heterogeneous healthcare systems, the Asian Thoracic Oncology Research Group (ATORG) convened a consensus meeting in Singapore on 26 April 2024 to discuss relevant issues spanning diagnostic testing to post-neoadjuvant treatment considerations and future directions. An interdisciplinary group of 19 experts comprising medical oncologists, thoracic surgeons, radiation oncologists, pulmonologists and pathologists from Singapore, Hong Kong, Mainland China, Korea, Japan, Taiwan, India, Malaysia, Thailand, Vietnam and Australia met to discuss emerging data, identify existing gaps in clinical care and develop a multidisciplinary, multinational expert consensus statement on the peri-operative management of NSCLC tailored to the Asia-Pacific region.

Evaluating pathological complete response as an surrogate endpoint for long-term survival in patients with non-small cell lung cancer: a systematic review and meta-analysis

PURPOSE

Pathologic complete response (pCR) is deemed to associate with event-free survival (EFS) and overall survival (OS), however, whether it is suitable to serve as a surrogate endpoint for long-term survival in clinical trials of neo-adjuvant treatment for resectable NSCLC trials is still controversy. We aim to evaluate the role of pCR and its viability as a surrogate endpoint for EFS and OS in NSCLC.

METHODS

To investigate the association of pCR and EFS and OS, we performed a meta-analysis involving randomized clinical trials that have reported complete information on pCR rates with hazard ratios (HRs) for EFS and OS. A standard meta-analysis was conducted to determine the relationship between pCR rates and EFS and OS. Additionally, weighted regression analysis was performed to assess the associations between log relative risk (RR) for pCR and log HRs for EFS and OS, with the coefficient of determination (R 2 ) being used to quantify the correlations. Furthermore, the surrogate threshold effect (STE) was also used to evaluate the minimum value of the RR for pCR necessary to confidently predict a non-null effect on HRs for EFS and OS.

RESULTS

The meta-analysis included 14 randomized clinical trials. The high pCR rate group had significant improvement of EFS (HR = 0.69, 95%CI 0.55-0.86) and OS (HR = 0.82, 95%CI 0.72-0.94). A strong association was found between log RR for pCR and log HR for EFS (R 2  = 0.76; 95%CI 0.48-1.00) and a moderate correlation between log RR for pCR and log HR for OS (R 2  = 0.54; 95%CI 0.04-1.00). The STEs for pCR were 4.534 and 10.278 for EFS and OS, respectively. In the subgroup analysis, similar results were only observed in a partial set of comparisons.

CONCLUSIONS

A high pCR rate was associated with a long-term survival outcome. Strong association and moderate association were found between pCR and EFS, pCR and OS, respectively, which supports the application of pCR as a surrogate endpoint for long-term survival in RCTs for resectable NSCLC.

Navigating the landscape of neoadjuvant immunotherapy for NSCLC: progress and controversies

Recently, attention has increasingly centered on non-small-cell lung cancer (NSCLC) with immune checkpoint inhibitors application. Numerous clinical studies have underscored the potential of immunotherapy in treating resectable NSCLC, highlighting its role in improving patient outcomes. However, despite these promising results, there is ongoing debate regarding the efficacy of immunological combination therapy strategies, the prevalence of treatment-related side effects, the identification of predictive biomarkers, and various other challenges within the neoadjuvant context. Careful consideration is essential to maximize the benefits of immunotherapy for patients with resectable NSCLC. This article offers a detailed overview of recent advancements in neoadjuvant immunotherapy for resectable NSCLC. By examining these developments, we aim to provide new perspectives and valuable insights into the benefits and challenges of applying neoadjuvant immunotherapy in clinical settings.

Multi-omic profiling highlights factors associated with resistance to immuno-chemotherapy in non-small-cell lung cancer

Although immune checkpoint blockade (ICB) therapies have shifted the treatment paradigm for non-small-cell lung cancer (NSCLC), many patients remain resistant. Here we characterize the tumor cell states and spatial cellular compositions of the NSCLC tumor microenvironment (TME) by analyzing single-cell transcriptomes of 232,080 cells and spatially resolved transcriptomes of tumors from 19 patients before and after ICB-chemotherapy. We find that tumor cells and secreted phosphoprotein 1-positive macrophages interact with collagen type XI alpha 1 chain-positive cancer-associated fibroblasts to stimulate the deposition and entanglement of collagen fibers at tumor boundaries, obstructing T cell infiltration and leading to poor prognosis. We also reveal distinct states of tertiary lymphoid structures (TLSs) in the TME. Activated TLSs are associated with improved prognosis, whereas a hypoxic microenvironment appears to suppress TLS development and is associated with poor prognosis. Our study provides novel insights into different cellular and molecular components corresponding to NSCLC ICB-chemotherapeutic responsiveness, which will benefit future individualized immuno-chemotherapy.

Clinical efficacies of different neoadjuvant therapies for non-small cell lung cancer

Neoadjuvant therapy followed by surgery is a common clinical strategy for operable non-small cell lung cancer (NSCLC), and the mainstream neoadjuvant therapies include chemoimmunotherapy, targeted therapy, and chemotherapy. However, there is a lack of studies to report the difference in benefits between these treatment modalities in the same institution. Therefore, this study aimed to depict the short-term efficacy of radiology and pathology achieved by different therapies and their impact on long-term survival as well as the underlying clinical significance. A total of 243 NSCLC patients who underwent different neoadjuvant therapies were eligible for inclusion. Demographic, radiological, and pathological features of patients were recorded. The event-free survival (EFS) outcome was analyzed using Kaplan-Meier analysis. The objective response rates (ORR) of primary tumor in the chemoimmunotherapy, targeted therapy, and chemotherapy cohorts were 48.95 %, 57.58 %, and 34.09 % respectively, major pathological response (MPR) rates were 58.74 %, 15.15 %, and 20.83 % (P<.0001), and pathological complete response (pCR) rates were 41.26 %, 0 %, and 11.11 % (P<.0001). For consistency between imaging and pathological evaluation, Cohen's Kappa were 0.275, 0.233, and 0.330. The EFS of MPR group was significantly longer than that of non-MPR group in the chemoimmunotherapy and chemotherapy cohorts (P=.0077**&.0343*, HR=0.3287&0.3715), but this improvement was not observed in the targeted therapy cohort. Neoadjuvant chemoimmunotherapy often underestimates pathological efficacy in imaging but shows consistent long-term outcomes. Neoadjuvant chemotherapy with moderate overall effectiveness has a significant correlation between short-term benefits and reduced recurrence. Neoadjuvant targeted therapy shows remarkable short-term imaging improvements but often fails to convert into sustained long-term survival.

[Neoadjuvant therapy for resectable non-small cell lung cancer]

Treatment perspectives for non-small cell lung cancer (NSCLC) have been significantly expanded by the integration of immune checkpoint inhibitors into multimodal therapy concepts. Currently, combined, immune checkpoint-inhibitor-based therapy concepts are also advancing into early, resectable stages of NSCLC. Neoadjuvant and perioperative chemoimmunotherapy opened up a promising new preoperative treatment approach, but also raises some new questions and challenges. With the expanded perioperative treatment options and the perspective on a further improvement in the absence of recurrence after tumor resection, there is push towards comprehensively collecting therapy-relevant findings for imaging, molecular and histopathological diagnostics at an early stage. All patients with lung carcinoma, regardless of the therapy intention, should be presented to an interdisciplinary tumor board with thoracic oncological expertise. This is regularly given in certified lung cancer centers.A standardized procedure contributes to optimized pre-therapeutic diagnostics and facilitates coordination for the best possible multimodal approach in the interdisciplinary tumor board. In the case of centrally located resectable tumors, for example, neoadjuvant treatment increases the chances of a procedure that is as parenchymal sparing as possible. Some questions cannot yet be answered conclusively. Perioperative systemic therapy with molecular-targeted and immune checkpoint inhibitors is the subject of numerous ongoing studies. The considerable dynamics in newly approved therapies and the development of perioperative therapy concepts require continuous adaptation of diagnostic algorithms and standards. Integration into standard pre-surgical routine makes rapid classification of the relevant findings as well as close coordination between the diagnostic and interventional disciplines essential.

Drug-Eluting Beads Bronchial Arterial Chemoembolization Combined with Immunotherapy Resulted in Pathological Complete Response of Squamous Cell Lung Cancer: A Case Report

The incidence of lung cancer is the highest among all tumors, and treatment has become an urgent problem to be solved. The Drug-eluting bead-based bronchial arterial chemoembolization (DEB-BACE) combination immunotherapy is a rare neoadjuvant therapy for lung cancer surgery, which can significantly reduce the time it takes for lung cancer patients to undergo surgery.We report a male patient, aged 59-year-old, with Stage-III b squamous cell lung cancer accompanied by hemoptysis underwent surgical resection after DEB-BACE combination immunotherapy treatment 21 days later without obvious adverse events. A pathologic complete response (pCR) was observed postoperatively, and the patient has made a successful recovery. The DEB-BACE combined with immunotherapy might be a new neoadjuvant therapy option for locally advanced non-small cell lung.

Neoadjuvant immune checkpoint inhibitor reduced recurrence in operable NSCLC patients with pathological complete response: a retrospective analysis

BACKGROUND

This study aimed to evaluate if neoadjuvant immune checkpoint inhibitor (ICI) plus chemotherapy (CT) reduced tumor recurrence after surgery than neoadjuvant CT alone in non-small cell lung cancer (NSCLC) patients with pathologic complete response (pCR).

METHODS

From January 1st 2019 to April 30th 2022, 16 NSCLC patients with pCR who received both neoadjuvant ICI and CT were designated as ICI/CT group. Another 8 patients, who received neoadjuvant CT alone, were designated as CT group. The tumor recurrence and patients' survival status were analyzed.

RESULTS

Squamous cell carcinoma was the predominant histology type in both groups. The CT group had higher percentage of patients who received adjuvant CT than the ICI/CT group (100% vs. 75%, p = 0.046). All patients had been followed up for at least 20 months. At 20 months after surgery, the ICI/CT group had a tumor recurrence rate of 6.25%, which was significantly lower than 37.5% recurrence rate of the CT group. One patient of the CT group died of gastrointestinal hemorrhage and severe anemia at 11 months after surgery, and no patient in the ICI/CT group died. During adjuvant therapy, the ICI/CT group had significantly lower risk of anemia (12.5% vs. 50%) than the CT group (p = 0.046).

CONCLUSION

The study found that in NSCLC patients with pCR, neoadjuvant ICI reduced tumor recurrence rate. This indicated that like in advanced stage NSCLC, the ICI might bring similar long-term anti-tumor effect in operable NSCLC patients.

Update on Practical Management of Early-Stage Non-Small Cell Lung Cancer (NSCLC): A Report from the Ontario Forum

Therapeutic strategies for early-stage non-small cell lung cancer (NSCLC) are advancing, with immune checkpoint inhibitors (ICIs) and targeted therapies making their way into neoadjuvant and adjuvant settings. With recent advances, there was a need for multidisciplinary lung cancer healthcare providers from across Ontario to convene and review recent data from practical and implementation standpoints. The focus was on the following questions: (1) To what extent do patient (e.g., history of smoking) and disease (e.g., histology, tumor burden, nodal involvement) characteristics influence treatment approaches? (2) What are the surgical considerations in early-stage NSCLC? (3) What is the role of radiation therapy in the context of recent evidence? (4) What is the impact of biomarker testing on treatment planning? Ongoing challenges, treatment gaps, outstanding questions, and controversies with the data were assessed through a pre-meeting survey, interactive cases, and polling questions. By reviewing practice patterns across Ontario cancer centers in the context of evolving clinical data, Health Canada indications, and provincial (Cancer Care Ontario [CCO]) funding approvals, physicians treating lung cancer voiced their opinions on how new approaches should be integrated into provincial treatment algorithms. This report summarizes the forum outcomes, including pre-meeting survey and polling question results, as well as agreements on treatment approaches based on specific patient scenarios.

Real-World Clinical Outcomes of Neoadjuvant Platinum-Based Chemotherapy with Nivolumab in Non-Small Cell Lung Cancer

Background: Lung cancer is among the most prevalent and serious forms of cancer, characterized by an allogenic phenotype that presents significant therapeutic challenges. Materials and Methods: We analyzed medical records from January 2022 to August 2023, focusing on individuals aged 18 and older diagnosed with resectable NSCLC who received neoadjuvant chemo-immunotherapy prior to surgical intervention. Results: The cohort comprised 56 patients, predominantly smokers (95%) and male (74%), with 80% presenting the disease at stage III. Of the participants, 44 underwent surgery, with 95% receiving lobar resection. Clinical assessments via PET-CT imaging revealed an 86% rate of response or disease stabilization, while pathological evaluations showed complete and major pathological responses in 61% of cases. Conclusions: This real-world data supports the safety and efficacy of incorporating immune checkpoint inhibitors in the neoadjuvant treatment of NSCLC, followed by surgical resection.

Pathological responses of primary tumor and lymph nodes in non-small cell lung cancer after neoadjuvant chemoimmunotherapy: a retrospective real-world study

Background

In patients with non-small cell lung cancer (NSCLC) receiving neoadjuvant chemoimmunotherapy (NCIT), inconsistent pathological responses between the tumor and lymph nodes (LNs) are often observed. There has been limited evidence comparing the different responses of tumors and LNs in those patients. This retrospective real-world analysis intended to evaluate the clinical and pathological response of primary tumors and LNs, and the long-term outcomes in NSCLC patients after NCIT.

Methods

We included resectable NSCLC patients who had received neoadjuvant therapy and had available clinicopathological records. The progression-free survival (PFS) and overall survival (OS) outcomes were analyzed using survival analysis.

Results

In total, 204 patients were included in the final analysis. Patients were predominantly male (85.8%) and ever-smokers (66.2%), with a median age of 63 years. No significant difference was observed in intraoperative bleeding (P=0.51 and P=0.54) and operation time (P=0.57 and P=0.58) between the major pathologic response (MPR) and pathological complete response (pCR) group, respectively. Patients who were male (pCR, P=0.01; MPR, P=0.004), with squamous cell carcinoma (SCC) (pCR, P=0.02; MPR, P=0.001), and overall response rate (ORR) (pCR, P<0.001; MPR, P<0.001) demonstrated significantly higher rates of pCR and MPR. The median follow-up time for all patients in this study was 23 months. Patients with MPR (P=0.004) and pCR (P=0.02) experienced prolonged PFS, but not OS (MPR, P=0.08; pCR, P=0.15). In terms of yield pathological tumor MPR (ypTMPR) and yield pathological LNs stage (ypN), Kaplan-Meier analyses demonstrated that there was a better PFS for the ypTMPR(+)/ypN(0) group, followed by ypTMPR(-)/ypN(0), ypTMPR(+)/ypN(0), and ypTMPR(-)/ypN(1+2) (P=0.01). The average PFS time was 35.7, 31.7, 29.4, and 28.7 months, respectively. After achieving MPR, the probability of local recurrence or distant metastasis was 7.3%, 25%, 23.5%, and 23.7%, respectively.

Conclusions

In this real-world study, the combination of tumor and LNs responses was significantly associated with prognosis, and we demonstrated that ypTMPR(+)/ypN(0) group had a better prognosis, followed by ypTMPR(-)/ypN(0), ypTMPR(+)/ypN(0), and ypTMPR(-)/ypN(1+2). We advocate for ypTMPR(+)/ypN(0) status as a better surrogate of PFS in resectable NSCLC patients after NCIT.

A prospective study of neoadjuvant pembrolizumab plus chemotherapy for resectable esophageal squamous cell carcinoma: The Keystone-001 trial

In this phase II study, 47 patients with locally advanced, resectable esophageal squamous cell carcinoma (ESCC) received three cycles of pembrolizumab plus chemotherapy, followed by Da Vinci robot-assisted surgery. The primary endpoints were safety and major pathological response (MPR). Key secondary endpoints included complete pathological response (pCR) and survival. No grade ≥3 adverse events or surgical delays occurred during neoadjuvant therapy. Among 46 patients studied for efficacy, the MPR and pCR rates were 72% and 41%, respectively. After a median follow-up of 27.2 months, the 2-year overall survival (OS) and disease-free survival (DFS) rates were 91% and 89%, respectively. Expansion of TRGC2+ NKT cells in peripheral blood correlated with neoadjuvant treatment effectiveness, which was validated by in vitro organoid experiments and external cancer datasets, and its functional classification and mechanism of action were further explored. These findings show preoperative pembrolizumab plus chemotherapy is a promising therapeutic strategy for resectable ESCC.