Safety and effectiveness of neoadjuvant immunotherapy combined with chemotherapy followed by surgical resection in patients with stage I-IIIA small-cell lung cancer: a retrospective single-arm clinical trial

Neoadjuvant immunochemotherapy demonstrated improved efficacy and comparable safety to neoadjuvant chemotherapy for limited-stage small-cell lung cancer: a cohort study

Background

Small-cell lung cancer (SCLC) accounts for 10-15% of all lung cancers. Neoadjuvant therapy followed by surgery has been applied in treatment of limited-stage SCLC (LS-SCLC). The synergistic effect of neoadjuvant immunochemotherapy (NIC) has been validated in the treatment of non-small cell lung cancer (NSCLC). Therefore, we compared the safety and efficacy between NIC and neoadjuvant chemotherapy (NC) for treating LS-SCLC.

Methods

This retrospective study included 10 patients diagnosed with LS-SCLC (stage I-IIIB) from 2019 to 2021. Five patients received NIC, while the other five received NC. Patients received two cycles of etoposide and cisplatin chemotherapy (EP) regimen (75 mg/m2 of cisplatin and 160 mg/m2 of etoposide) with or without immunotherapy (durvalumab or pembrolizumab) every 3 weeks before surgery. Imaging evaluation was performed before neoadjuvant therapy and surgery. Imaging and pathological tumor response, neoadjuvant treatment-related adverse events, perioperative information, and complications were evaluated. The follow-up data were obtained from the regular reviews in hospital and by telephone. The follow-up was terminated at December 2023 or if the patient died or experienced recurrence.

Results

The objective response rate (ORR) was 80% (4/5) in the NIC group and 100% (5/5) in the NC group. No patients experienced progressive disease (PD). Patients in the NIC group achieved more improvement of pulmonary function than did those in the NC group. All NIC and NC patients had R0 resection. No significant difference in surgical information was found between the two groups. One of the five patients in the NIC group experienced alveolopleural fistula, while one of the five patients in the NC group experienced respiratory failure postoperatively and died thereafter. One patient in the two groups was diagnosed with hydrothorax after tube removal. Pathological downstaging occurred in 4 patients in the NIC group and 2 patients in the NC groups. The rate of pathological complete remission (pCR) and major pathological response (MPR) was 20% and 40% in the NIC group, respectively, while in the NC group, it was 20% and 20%, respectively. In one patient with NIC, adjuvant therapy was abandoned due to hepatic insufficiency. During the period of follow-up, one patient in the NIC group experienced brain metastasis 1 year after surgery, while one patient in the NC group was diagnosed with local lymph node metastasis and distant metastasis half a year later.

Conclusions

NIC might provide greater advantages in downstaging, pulmonary function improvement and pathological regression in patients with LS-SCLC than NC while providing similarly safety and surgical feasibility. These findings may help clinicians develop more individualized therapy. However, randomized controlled trials are required to further validate our findings.

Neoadjuvant programmed death ligand-1 with chemotherapy versus chemotherapy alone for limited-stage small-cell lung cancer: a retrospective study

Summary background

Our objective was to investigated the safety and feasibility of neoadjuvant treatment with PD(L)1 inhibitors and chemotherapy followed by surgery for resectable SCLC.

Methods

In this retrospective cohort study, we included patients with limited-stage SCLC treated with neoadjuvant chemotherapy (with/without)ICI at Beijing Chest Hospital (Beijing, China) between July 2020 and December 2021. Seventeen patients with LD-SCLC were enrolled in the study. Two groups were assigned for further statistical analysis: neoadjuvant chemotherapy (group C), in which only preoperative chemotherapy was administered; and neoadjuvant ICI (group I), in which surgery was combined with both preoperative ICI and chemotherapy. Patient demographics, radiological and pathological evaluations of tumor response, surgical information, toxicity profiles, tumor marker and follow-up results of both groups were evaluated.

Results

17 patients were included in this retrospective study, of which, 11 patients received ICI and chemotherapy-containing regimens and 6 patients received neoadjuvant chemotherapy only. Herein, we firstly reported that neoadjuvant PD-(L)1 blockade plus chemotherapy led to a pCR rate of 45.5% in patients with limited-stage small cell lung cancer. The MPR rate of 72.7% due to treatment with neoadjuvant PD-(L)1 blockade plus chemotherapy group (group I) was significantly higher than those in the traditional neoadjuvant chemotherapy group (16.7%)(group C). We first found that ProGRP is a good the evaluation indicator for neoadjuvant immunotherapy in small cell lung cancer and found that the ProGRP levels decreased significantly in both group after neoadjuvant therapy, and it was more obvious in group I(P=0.003).All Of the 17 patients (100.0%) had R0 resection. There were no perioperative deaths.

Conclusions

Neoadjuvant immunotherapy shows lower toxicity and fewer perioperative complications. ICI combined chemotherapy can achieve more pathological relief and clinical benefits in the neoadjuvant treatment of LS-SCLC without increased irAE and perioperative complications. However, the small sample size limits the reliability of the research.

Preoperative immunochemotherapy versus chemotherapy as first-line treatment for patients with stage I-IIIB small-cell lung cancer

BACKGROUND

To date, there remains a paucity of comparative investigations pertaining to preoperative immunochemotherapy and conventional chemotherapy in the context of limited-stage small-cell lung cancer (LS-SCLC) patients. This study conducted a comprehensive comparative assessment concerning the safety and efficacy profiles of preoperative immunochemotherapy and chemotherapy in individuals diagnosed with stage I-IIIB SCLC.

METHODS

This investigation collected 53 consecutive patients diagnosed with LS-SCLC spanning stage I to IIIB who underwent preoperative immunochemotherapy or conventional chemotherapy at our hospital from January 2019 to July 2021. Patients were allocated to receive 2-4 cycles of neoadjuvant immunochemotherapy or chemotherapy, with each cycle lasting three weeks. Comprehensive analyses encompassed baseline characteristics, clinical staging, tumor response, intraoperative and postoperative outcomes, and the assessment of treatment-related adverse events (trAEs). The follow-up period is extended for a minimum of one year after surgery. The primary endpoint embraced the evaluation of the pathological response [major pathological response (MPR) and pathological complete remission (pCR)], while secondary endpoints encompassed objective response rate (ORR), trAEs, surgical resection rates, and disease-free survival (DFS).

RESULTS

The objective response rate of the immunochemotherapy group was 89.5%, while that of the chemotherapy group was 75.0% (P = 0.206). A total of 19 patients underwent surgery among these 53 patients, with 14 patients in the neoadjuvant chemoimmunotherapy group and 5 patients in the chemotherapy group. And the surgical resection rate of the immunochemotherapy group was 48.3% (14/29), which was higher than the chemotherapy group (20.8%, 5/24, P = 0.038). The rate of MPR in the immunochemotherapy group was 57.1% (8/14) and 40.0% (2/5) in the chemotherapy group (P = 0.891). The rates of pCR in the immunochemotherapy and chemotherapy group were 50.0% (7/14) and 0.0% (0/5), respectively (P = 0.106).The median DFS for both groups were not reached (P = 0.43). The 2-year DFS rate was 21.4% for the immunochemotherapy group versus 40.0% for the chemotherapy group. There was no significant difference in the incidence of grade 3-4 adverse events between the immunochemotherapy group and the chemotherapy group.

CONCLUSIONS

For patients with stage I-IIIB SCLC, neoadjuvant immunochemotherapy is feasible and safe. Although immunochemotherapy did not significantly associated with longer DFS versus chemotherapy alone in patients with stage I-IIIB SCLC, it can produce significant downstaging and increase the possibility of surgery.

Pathological complete response to neoadjuvant therapy with serplulimab and chemotherapy in stage IIIB small cell lung cancer: a case report and literature review

Chemotherapy combined with immunotherapy has significantly improved survival in patients with extensive-stage small cell lung cancer (ES-SCLC), and neoadjuvant immunotherapy combined with chemotherapy has emerged as the standard treatment for those with resectable non-small cell lung cancer (NSCLC). However, the potential benefits of surgery following neoadjuvant immunotherapy combined with chemotherapy in locally advanced SCLC remain unclear. Herein, we report a patient diagnosed with stage IIIB SCLC, who was administered five cycles of neoadjuvant serplulimab combined with chemotherapy followed by surgery, and subsequently achieved a pathologic complete response (pCR). Within a follow-up duration of six months, the patient displayed neither recurrence nor metastasis and experienced no treatment-related adverse reactions of any grade. Based on this case, for locally advanced SCLC, neoadjuvant serplulimab combined with chemotherapy followed by surgery may present an effective, safe, and potentially curative treatment strategy. Nonetheless, further prospective studies are needed to verify our findings.