51
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Taber S, Pfannschmidt J, Bauer TT, Blum TG, Grah C, Griff S. Is Adjuvant Radiochemotherapy Always Mandatory in Patients with Resected N2 Non-Small Cell Lung Cancer? Thorac Cardiovasc Surg 2021; 70:244-250. [PMID: 33601469 DOI: 10.1055/s-0041-1723081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND In patients with non-small cell lung cancer (NSCLC), the pathologic union for international cancer control (UICC) stage IIIA is a heterogeneous entity, with different forms of N2-lymph node involvement representing different prognoses. Although a multimodality treatment approach, including surgery, systemic therapy, and/or radiotherapy, is almost always recommended, in this retrospective observational study, we sought to determine whether long-term survival might be possible in selected patients who are treated with complete surgical resection alone. METHODS Between 2013 and 2018, we retrospectively identified 24 patients with NSCLC (16 men and 8 women), who were found to have pathologic N2-lymph node involvement, and were treated with complete surgical lung resection and systematic mediastinal and hilar lymph node dissection but no neoadjuvant or adjuvant treatment. RESULTS The most frequent reason (n = 14) for forgoing adjuvant treatment was patient refusal. The mean overall survival (OS) was 34.5 months (interquartile range [IQR]: 15.5-53.5 months). The mean disease-free survival (DFS) was 18 months (IQR: 4.75-46.75 months). We identified five patients who survived at least 5 years without recurrence (21%). In each of these cases, the nodal metastases were restricted to a single level and no extracapsular lymph node involvement were detected. Additionally, worse DFS was associated with pT3/4 (vs. a lower T-stage), as well as microscopic lymphovascular invasion. CONCLUSION Although the small sample size precludes any definitive conclusions, it was possible to demonstrate that long-term survival without neoadjuvant and adjuvant treatment is possible in some patients if complete tumor and nodal resection is performed.
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Affiliation(s)
- Samantha Taber
- Department of Thoracic Surgery, Lung Clinic Heckeshorn, HELIOS Emil von Behring, Berlin, Germany
| | - Joachim Pfannschmidt
- Department of Thoracic Surgery, Lung Clinic Heckeshorn, HELIOS Emil von Behring, Berlin, Germany
| | - Torsten T Bauer
- Department of Pneumology, Lung Clinic Heckeshorn, HELIOS Emil von Behring, Berlin, Germany
| | - Torsten G Blum
- Department of Pneumology, Lung Clinic Heckeshorn, HELIOS Emil von Behring, Berlin, Germany
| | - Christian Grah
- Department of Internal Medicine and Respiratory Medicine, Gemeinschaftskrankenhaus Havelhohe gGmbH, Berlin, Germany
| | - Sergej Griff
- Department of Pathology, Institute of Pathology, HELIOS Klinikum Emil von Behring GmbH, Berlin, Germany.,Department of Pathology, Brandenburg Medical School Theodor Fontane, Neuruppin, Brandenburg, Germany
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52
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Controversies and challenges in the pathologic examination of lung resection specimens after neoadjuvant treatment. Lung Cancer 2021; 154:76-83. [PMID: 33631448 DOI: 10.1016/j.lungcan.2021.02.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 01/06/2023]
Abstract
New therapy approaches in the treatment of surgically resectable non-small cell lung cancer (NSCLC) challenge the traditional handling and examination of pathology specimens. The increasingly common use of neoadjuvant therapies before surgical resection, due to advantages in novel drug administration, tolerance, and measurement of radiographic and pathologic response compared to adjuvant treatment, has the potential to alter the microscopic tumor appearance and its biology. Currently, many clinical trials use pathologic response as a surrogate endpoint of clinical efficacy, since the extent of residual viable tumor appears to correlate with outcome in patients treated with neoadjuvant chemotherapy. Consequently, pathologic assessment of the extent of residual viable tumor is of paramount importance. However, high level evidence-based guidelines on how to process and evaluate such specimens are lacking. Moreover, while pathologic response has been shown to be associated with survival after chemotherapy, its significance after immunotherapy remains to be determined. Additionally, many clinical trials do not routinely include pathologists in trial design, which may lead to non-standardized evaluation of pathologic response. Although recently, several algorithms have been proposed to address these issues, none of them represents evidence-based recommendations or is universally applied. Therefore, controversies and challenges continue to exist, raising concerns about the validity, reproducibility, and comparability of the results of many neoadjuvant clinical trials. Herein, we discuss the current difficulties in pathologic specimen evaluation following neoadjuvant therapy in NSCLC and propose potential approaches to overcome these challenges.
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53
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Huynh C, Walsh LA, Spicer JD. Surgery after neoadjuvant immunotherapy in patients with resectable non-small cell lung cancer. Transl Lung Cancer Res 2021; 10:563-580. [PMID: 33569337 PMCID: PMC7867741 DOI: 10.21037/tlcr-20-509] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Surgery is the standard of care for patients with operable non-small cell lung cancer (NSCLC). However, as a single modality, surgery for early stage or locally advanced NSCLC remains associated with high rates of local and distant recurrence. The addition of neoadjuvant or adjuvant chemotherapy has modestly improved outcomes. While systemic therapy paired with surgery for other malignancies such as breast cancer have resulted in far better outcomes for equivalent stage designations, outcome improvements for operable NSCLC have lagged in part as a result of trials where adjuvant chemotherapy seemed to incur harm for stage IA patients and only modest survival benefit for stage IB–IIIA patients (AJCC 7th ed.). In recent years, immunotherapy for NSCLC has emerged as a systemic therapy with significant benefit over traditional chemotherapy regimens. These advances with immune checkpoint inhibitors (ICIs) have opened the door to administering peri-operative immunotherapy for operable NSCLC. As a result, a great multitude of studies investigating the use of immunotherapy in combination with surgery for NSCLC as well as several other malignancies have emerged. In this review, we outline the rationale for neoadjuvant immunotherapy in the treatment of operable NSCLC and summarize the available evidence that include preoperative ICI as a single modality or in combination with systemic agents and/or radiotherapy. Further, we summarize how such treatment trajectories open multiple unique windows of opportunity for scientific discovery and potential therapeutic gains for these vulnerable patients.
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Affiliation(s)
- Caroline Huynh
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Rosalind and Morris Goodman Cancer Research Centre, McGill University, Montreal QC, Canada
| | - Logan A Walsh
- Rosalind and Morris Goodman Cancer Research Centre, McGill University, Montreal QC, Canada.,Department of Human Genetics, McGill University, Montreal, QC, Canada
| | - Jonathan D Spicer
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Rosalind and Morris Goodman Cancer Research Centre, McGill University, Montreal QC, Canada.,Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University, Montreal, QC, Canada
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54
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Calvo V, Aliaga C, Carracedo C, Provencio M. Prognostic factors in potentially resectable stage III non-small cell lung cancer receiving neoadjuvant treatment-a narrative review. Transl Lung Cancer Res 2021; 10:581-589. [PMID: 33569338 PMCID: PMC7867763 DOI: 10.21037/tlcr-20-515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Lung cancer is the leading cause of cancer-related death in worldwide. The most important treatment for patients with stage I and II non-small cell lung cancer (NSCLC) is surgery. Resected stage II and III NSCLC patients should be offered adjuvant chemotherapy and in patients with resected stage IB disease and with a primary tumor >4 cm this treatment could be considered. The treatment of resectable locally advanced NSCLC should be evaluated within an experienced multidisciplinary team. Neoadjuvant chemotherapy can be considered in patients with resectable disease and clear candidates for complementary chemotherapy. Neoadjuvant chemotherapy has similar impact on overall survival (OS) than adjuvant chemotherapy, however postoperative chemotherapy has more evidence-based support. Immunotherapy is being studied in early and locally advanced NSCLC as a neoadjuvant or adjuvant treatment. Different prognostic factors have been described in patients with stage III who have received neoadjuvant treatment, which we intend to review in this article.
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Affiliation(s)
- Virginia Calvo
- Medical Oncology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Carlos Aliaga
- Medical Oncology Department, Aliada Contra el Cáncer, Lima, Perú
| | - Carlos Carracedo
- Medical Oncology Department, Aliada Contra el Cáncer, Lima, Perú
| | - Mariano Provencio
- Medical Oncology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
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55
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Liang W, Cai K, Chen C, Chen H, Chen Q, Fu J, Hu J, Jiang T, Jiao W, Li S, Liu C, Liu D, Liu W, Liu Y, Ma H, Pan X, Qiao G, Tian H, Wei L, Zhang Y, Zhao S, Zhao X, Zhou C, Zhu Y, Zhong R, Li F, Rosell R, Provencio M, Massarelli E, Antonoff MB, Hida T, de Perrot M, Lin SH, Di Maio M, Rossi A, De Ruysscher D, Ramirez RA, Dempke WCM, Camidge DR, Guibert N, Califano R, Wang Q, Ren S, Zhou C, He J. Expert consensus on neoadjuvant immunotherapy for non-small cell lung cancer. Transl Lung Cancer Res 2020; 9:2696-2715. [PMID: 33489828 PMCID: PMC7815365 DOI: 10.21037/tlcr-2020-63] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Wenhua Liang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | | | - Chun Chen
- Fujian Medical University Union Hospital, Fuzhou, China
| | - Haiquan Chen
- Fundan University Shanghai Cancer Center, Shanghai, China
| | - Qixun Chen
- Zhejiang Cancer Hospital, Hangzhou, China
| | - Junke Fu
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jian Hu
- The First Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | | | - Wenjie Jiao
- The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shuben Li
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Changhong Liu
- The Second Hospital of Dalian Medical University, Dalian, China
| | - Deruo Liu
- China-Japan Friendship Hospital, Beijing, China
| | - Wei Liu
- The First Bethune Hospital of Jilin University, Changchun, China
| | - Yang Liu
- Chinese PLA General Hospital, Beijing, China
| | - Haitao Ma
- The Affiliated Hospital of Soochow University, Suzhou, China
| | | | - Guibin Qiao
- Guangdong Provincial People's Hospital, Guangzhou, China
| | - Hui Tian
- Qilu Hospital of Shandong University, Ji'nan, China
| | - Li Wei
- Henan Provincial People's Hospital, Zhengzhou, China
| | - Yi Zhang
- Xuanwu Hospital Capital Medical University, Beijing, China
| | - Song Zhao
- The Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaojing Zhao
- Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chengzhi Zhou
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Yuming Zhu
- Shanghai Pulmonary Hospital, Shanghai, China
| | - Ran Zhong
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Feng Li
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Rafael Rosell
- Department of Medical Oncology, University of Barcelona, Hospital de Badalona Germans Trias i Pujol, Barcelona, Spain
| | | | | | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Toyoaki Hida
- Department of Thoracic Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Marc de Perrot
- Toronto Mesothelioma Research Program, Toronto General Hospital, Toronto, ON, Canada
| | - Steven H Lin
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Massimo Di Maio
- Department of Oncology, University of Turin/Division of Medical Oncology, Ordine Mauriziano Hospital, Turin, Italy
| | - Antonio Rossi
- Oncology Center of Excellence, Therapeutic Science & Strategy Unit, IQVIA, Milan, Italy
| | - Dirk De Ruysscher
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Robert A Ramirez
- Department of Internal Medicine, Section of Hematology/Oncology, Ochsner Medical Center, Kenner, LA, USA
| | - Wolfram C M Dempke
- Department of Hematology and Oncology, University Medical School, Munich, Germany
| | - D Ross Camidge
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nicolas Guibert
- Thoracic Oncology Department, Larrey Hospital, University Hospital of Toulouse, Toulouse, France
| | - Raffaele Califano
- Department of Medical Oncology, The Christie NHS Foundation Trust, and Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Qi Wang
- Department of Respiratory Medicine, The Second Hospital, Dalian Medical University, Dalian, China
| | - Shengxiang Ren
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Caicun Zhou
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jianxing He
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, Guangzhou, China
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56
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White AA, Lee DN, Mazzola E, Kucukak S, Polhemus E, Jaklitsch MT, Mentzer SJ, Wee JO, Bueno R, Swanson SJ. Adjuvant therapy following induction therapy and surgery improves survival in N2-positive non-small cell lung cancer. J Surg Oncol 2020; 123:579-586. [PMID: 33259637 DOI: 10.1002/jso.26305] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 10/30/2020] [Accepted: 11/05/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate treatment strategies and factors influencing overall survival (OS) and disease-free survival (DFS) in resectable, non-small cell lung cancer (NSCLC) with mediastinal (N2) lymph node metastasis. METHODS All patients undergoing surgery for NSCLC with N2 disease between 2006 and 2016 were included. Treatment approaches included surgery only, neoadjuvant therapy followed by surgery, surgery followed by adjuvant therapy, and neoadjuvant therapy followed by surgery and adjuvant therapy (triple therapy). Patient clinical and pathologic data were retrospectively collected. RESULTS A total of 281 patients were included in the study. In total, 209 patients had neoadjuvant therapy, 47.4% of which went on to received additional adjuvant therapy. The pathologic complete response rate was 12.9%. The treatment strategy which included triple therapy was isolated as a significant contributor to improved OS and DFS. Nodal downstaging (N0) after induction therapy conferred an OS benefit (38.3% vs. 15.6%, p = .03). Patients with single-station N2 disease experienced higher DFS. Video-assisted thoracic surgery (VATS) lobectomy completion rates were higher at the end of the study period compared to the beginning (p < .001). CONCLUSIONS Patients who undergo neoadjuvant therapy for N2-positive NSCLC may benefit from additional adjuvant therapy. Single-station N2 disease confers higher DFS. VATS completion rates for lobectomy increase as experience increases.
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Affiliation(s)
- Abby A White
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Daniel N Lee
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Emanuele Mazzola
- Division of Biostatistcs, Department of Data Sciences, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Suden Kucukak
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Emily Polhemus
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael T Jaklitsch
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Steven J Mentzer
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jon O Wee
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Raphael Bueno
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Scott J Swanson
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
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57
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Ren Y, Tang H, Zhang J, She Y, Sun X, Xie D, Chen C. Bayesian network meta-analysis of efficacy and safety of neoadjuvant therapy for non-small-cell lung cancer. Ther Adv Med Oncol 2020; 12:1758835920973567. [PMID: 33240402 PMCID: PMC7675866 DOI: 10.1177/1758835920973567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/23/2020] [Indexed: 12/25/2022] Open
Abstract
Objective: Neoadjuvant chemotherapy has increased the survival benefit of non-small cell lung cancer (NSCLC) patients. The effects of different neoadjuvant therapies are still controversial. We carried out the study to evaluate the efficacy and safety of neoadjuvant therapy. Methods: We performed a search of electronic databases (PubMed, Embase, MEDLINE, Cochrane) for randomized controlled trials (RCTs) comparing neoadjuvant treatment. After literature screening and data extraction, efficacy, and safety were analyzed by the Bayesian network meta-analysis (NMA). Results: A total of 19 RCTs were included, covering 3276 patients and six kinds of neoadjuvant therapies, including immunotherapy, targeted therapy, chemotherapy drugs and radiotherapy. Erlotinib, the first-generation epidermal growth factor receptor tyrosine inhibitors (EGFR TKIs), neoadjuvant targeted therapy is best for improving overall survival (OS) and progression-free survival (PFS), which is superior to other neoadjuvant therapy, such as neoadjuvant chemotherapy with platinum drugs [hazard ratio (HR) 0.39, 95% confidence intervals (CIs) 0.16–0.96], neoadjuvant chemoradiotherapy (HR 0.37, 95% CI 0.14–0.96) and neoadjuvant chemotherapy with non-platinum drugs (HR 0.25, 95% CI 0.07–0.90). OS of all neoadjuvant therapies is superior to surgery alone, but only neoadjuvant chemotherapy with platinum drugs showed a significant advantage (HR 0.76, 95% CI 0.59–0.93). Besides, for the stage IIIA N2 NSCLC patients, no significant difference was found between neoadjuvant therapies. Conclusions: Targeted neoadjuvant therapy is the best treatment for prolonging PFS. The neoadjuvant chemotherapy with platinum drugs was associated with the better OS benefits for patients with NSCLC, compared with surgery alone. There is no significant difference in the efficacy of neoadjuvant therapy for the stage IIIA N2 NSCLC.
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Affiliation(s)
- Yijiu Ren
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Hai Tang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Jie Zhang
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Yunlang She
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Xiaoting Sun
- Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, No. 507, Zheng Min Road, Shanghai 200433, China
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58
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Dai J, Cheng Y, Wu J, Wang Q, Wang W, Yang J, Zhao Z, Lou X, Xia F, Wang S, Tang BZ. Modular Peptide Probe for Pre/Intra/Postoperative Therapeutic to Reduce Recurrence in Ovarian Cancer. ACS NANO 2020; 14:14698-14714. [PMID: 33174739 DOI: 10.1021/acsnano.9b09818] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Even with optimal surgery, 80% of patients with ovarian cancer will have recurrence. Adjuvant therapy can reduce the recurrence of tumors; however, the therapeutic effect is still not prominent. Herein, we designed a modular peptide probe (TCDTMP), which can be self-assembled into nanoparticles (NPs) by loading in miR-145-5p or VEGF-siRNA. In vivo, (1) preoperative administration of TCDTMP/miR-145-5p ensured that NPs were adequately accumulated in tumors through active targeting and increased the expression of miR-145-5p in tumors, thereby inducing tumor cell apoptosis. (2) Intraoperatively, most of the tumors were removed, while the microscopic residual tumors were largely eliminated by TCDTMP/miR-145-5p-mediated photodynamic therapy (PDT). (3) Postoperatively, TCDTMP/VEGF-siRNA were given for antiangiogenesis therapy, thus delaying the recurrence of tumors. This treatment was named a preoperative (TCDTMP/miR-145-5p)||intraoperative (surgery and PDT)||postoperative (TCDTMP/VEGF-siRNA) therapeutic system and abbreviated as the PIP therapeutic system, which reduced the recurrence of ovarian cancer in subcutaneous tumor models, intraperitoneal metastasis models, and patient-derived tumor xenograft models. Our findings provide a therapeutic system based on modular peptide probes to reduce the recurrence of ovarian cancer after surgery, which provides a perspective for the surgical management of ovarian cancer.
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Affiliation(s)
- Jun Dai
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430032, China
| | - Yong Cheng
- Engineering Research Center of Nano-Geomaterials of Ministry of Education, Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan 430074, China
| | - Jun Wu
- Engineering Research Center of Nano-Geomaterials of Ministry of Education, Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan 430074, China
| | - Quan Wang
- Engineering Research Center of Nano-Geomaterials of Ministry of Education, Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan 430074, China
| | - Wenwen Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430032, China
| | - Juliang Yang
- Engineering Research Center of Nano-Geomaterials of Ministry of Education, Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan 430074, China
| | - Zujin Zhao
- State Key Laboratory of Luminescent Materials and Devices, South China University of Technology, Guangzhou 510640, China
| | - Xiaoding Lou
- Engineering Research Center of Nano-Geomaterials of Ministry of Education, Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan 430074, China
| | - Fan Xia
- Engineering Research Center of Nano-Geomaterials of Ministry of Education, Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan 430074, China
| | - Shixuan Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430032, China
| | - Ben Zhong Tang
- State Key Laboratory of Luminescent Materials and Devices, South China University of Technology, Guangzhou 510640, China
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Mielgo-Rubio X, Calvo V, Luna J, Remon J, Martín M, Berraondo P, Jarabo JR, Higuera O, Conde E, De Castro J, Provencio M, Hernando Trancho F, López-Ríos F, Couñago F. Immunotherapy Moves to the Early-Stage Setting in Non-Small Cell Lung Cancer: Emerging Evidence and the Role of Biomarkers. Cancers (Basel) 2020; 12:E3459. [PMID: 33233705 PMCID: PMC7699975 DOI: 10.3390/cancers12113459] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 12/24/2022] Open
Abstract
Despite numerous advances in targeted therapy and immunotherapy in the last decade, lung cancer continues to present the highest mortality rate of all cancers. Targeted therapy based on specific genomic alterations, together with PD-1 and CTLA-4 axis blocking-based immunotherapy, have significantly improved survival in advanced non-small cell lung cancer (NSCLC) and both therapies are now well-established in this clinical setting. However, it is time for immunotherapy to be applied in patients with early-stage disease, which would be an important qualitative leap in the treatment of lung cancer patients with curative intent. Preliminary data from a multitude of studies are highly promising, but therapeutic decision-making should be guided by an understanding of the molecular features of the tumour and host. In the present review, we discuss the most recently published studies and ongoing clinical trials, controversies, future challenges and the role of biomarkers in the selection of best therapeutic options.
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Affiliation(s)
- Xabier Mielgo-Rubio
- Department of Medical Oncology, Hospital Universitario Fundación Alcorcón, Budapest 1 Alcorcón, 28922 Madrid, Spain
| | - Virginia Calvo
- Department of Medical Oncology, Puerta de Hierro Hospital, Joaquín Rodrigo 1, Majadahonda, 28222 Madrid, Spain; (V.C.); (M.P.)
| | - Javier Luna
- Department of Radiation Oncology, Fundacion Jimenez Diaz, Oncohealth Institute, Avda. Reyes Católicos 2, 28040 Madrid, Spain;
| | - Jordi Remon
- Department of Medical Oncology, Centro Integral Oncológico Clara Campal (HM-CIOCC), Hospital HM Delfos, HM Hospitales, 08023 Barcelona, Spain;
| | - Margarita Martín
- Department of Radiation Oncology, Ramón y Cajal University Hospital, M-607, 100, 28034 Madrid, Spain;
| | - Pedro Berraondo
- Division of Immunology and Immunotherapy, Cima Universidad de Navarra and Instituto de Investigacion Sanitaria de Navarra (IdISNA), 31008 Pamplona, Spain;
| | - José Ramón Jarabo
- Department of Thoracic Surgery, Hospital Clínico San Carlos, Calle del Prof Martín Lagos, s/n, 28040 Madrid, Spain; (J.R.J.); (F.H.T.)
| | - Oliver Higuera
- Department of Medical Oncology, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain; (O.H.); (J.D.C.)
| | - Esther Conde
- Pathology-Targeted Therapies Laboratory, HM Hospitales, 28015 Madrid, Spain; (E.C.); (F.L.-R.)
| | - Javier De Castro
- Department of Medical Oncology, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain; (O.H.); (J.D.C.)
| | - Mariano Provencio
- Department of Medical Oncology, Puerta de Hierro Hospital, Joaquín Rodrigo 1, Majadahonda, 28222 Madrid, Spain; (V.C.); (M.P.)
| | - Florentino Hernando Trancho
- Department of Thoracic Surgery, Hospital Clínico San Carlos, Calle del Prof Martín Lagos, s/n, 28040 Madrid, Spain; (J.R.J.); (F.H.T.)
| | - Fernando López-Ríos
- Pathology-Targeted Therapies Laboratory, HM Hospitales, 28015 Madrid, Spain; (E.C.); (F.L.-R.)
| | - Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Pozuelo de Alarcón, 28223 Madrid, Spain;
- Department of Radiation Oncology, Hospital La Luz, 28003 Madrid, Spain
- Department of Radiation Oncology, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
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60
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Rooker S, Schil PV, Brande FVD, Maeseneer MD. Current Outcome in Patients with Lung Cancer and Positive Mediastinoscopy. Acta Chir Belg 2020. [DOI: 10.1080/00015458.2001.12098634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- S. Rooker
- Department of Thoracic and Vascular Surgery, University Hospital of Antwerp, Edegem, Belgium
| | - P. Van Schil
- Department of Thoracic and Vascular Surgery, University Hospital of Antwerp, Edegem, Belgium
| | - F. Van den Brande
- Department of Thoracic and Vascular Surgery, University Hospital of Antwerp, Edegem, Belgium
| | - M. De Maeseneer
- Department of Thoracic and Vascular Surgery, University Hospital of Antwerp, Edegem, Belgium
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Abstract
Treatment of stage III non-small cell lung cancer (NSCLC) traditionally has involved combinations of chemotherapy, radiation, and surgical resection. Although the multimodality approach remains standard, only a fraction of patients with stage III lung cancer can undergo complete resection, and long-term prognosis remains poor. The PACIFIC trial generated significant enthusiasm when it demonstrated that the programmed death ligand-1 inhibitor, durvalumab, improved survival in patients with unresectable stage III NSCLC after completion of definitive concurrent chemoradiation. This article reviews the indications for traditional therapies in stage III NSCLC and highlights ongoing advances that have led to the incorporation of novel therapeutic agents.
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Affiliation(s)
- Nathaniel J Myall
- Department of Medicine, Division of Medical Oncology, Stanford Cancer Institute, Stanford, CA 94305, USA
| | - Millie Das
- Department of Medicine, Division of Medical Oncology, Stanford Cancer Institute, Stanford, CA 94305, USA; Department of Medicine, VA Palo Alto Health Care System, 3801 Miranda Avenue (111ONC), Palo Alto, CA 94304, USA.
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Adjuvant Chemotherapy Improves Survival in pN-positive Clinical Stage IIIA Non-Small Cell Lung Cancer After Neoadjuvant Therapy and Resection. Ann Thorac Surg 2020; 112:197-205. [PMID: 33121965 DOI: 10.1016/j.athoracsur.2020.08.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 08/01/2020] [Accepted: 08/31/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The utility of adjuvant chemotherapy (AC) after neoadjuvant therapy and curative intent surgery for clinical stage IIIA (cIIIA) non-small cell lung cancer (NSCLC) is not defined. We sought to evaluate the contribution of AC to overall survival (OS) in patients with cIIIA NSCLC who underwent neoadjuvant therapy followed by curative intent surgical resection. METHODS The National Cancer Database was queried from 2010 to 2016 for patients with cIIIA NSCLC who underwent curative intent surgical resection after neoadjuvant therapy. Patients were grouped by receipt of AC, and OS was calculated using the Kaplan-Meier method. The association between mortality and AC was evaluated using Cox regression. Ninety-day landmark and propensity score-matched analyses were performed to address bias associated with early postoperative morbidity and mortality. RESULTS Of 3847 patients who met the inclusion criteria, 780 received AC (20.2%). In the unadjusted cohort there was no difference in 5-year OS between the AC and no AC groups (42.8% vs 43.9%, P = .105). Cox regression demonstrated a decreased risk of mortality in pN > 0 patients receiving AC (hazard ratio, 0.79; 95% confidence interval, 0.68-0.92; P < .003), whereas no difference was seen in node-negative patients (hazard ratio, 0.95; 95% confidence interval, 0.78-1.17; P = .64). In the propensity score-matched groups OS was significantly increased in pN > 0 patients who received AC (5-year OS: 42.4% vs 37%, P < .01), whereas no survival benefit was seen in those who were pN0. CONCLUSIONS For patients with completely resected cIIIA NSCLC after neoadjuvant therapy, AC is associated with an increase in OS for patients with residual pathologic lymph node involvement.
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Surgical Management of Stage IIIA Non-small Cell Lung Cancer. CURRENT PULMONOLOGY REPORTS 2020. [DOI: 10.1007/s13665-020-00259-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Boada M, Sánchez-Lorente D, Libreros A, Lucena CM, Marrades R, Sánchez M, Paredes P, Serrano M, Guirao A, Guzmán R, Viñolas N, Casas F, Agustí C, Molins L. Is invasive mediastinal staging necessary in intermediate risk patients with negative PET/CT? J Thorac Dis 2020; 12:3976-3986. [PMID: 32944309 PMCID: PMC7475585 DOI: 10.21037/jtd-20-1248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background Tumor involvement of mediastinal lymph nodes is of high importance in non-small cell lung cancer (NSCLC). Invasive mediastinal staging is recommended in selected patients without evidence of mediastinal involvement on staging by imaging. In the present study we aimed to evaluate the effectiveness of invasive mediastinal staging in reducing pN2, its impact on survival and the risk factors for occult pN2. Methods Patients with NSCLC tumors larger than 3 cm, central tumors or cN1 cases treated in our institution between 2013 and 2018 were prospectively included in the study. Incidence of pN2 and overall survival was compared among invasively staged (IS) and non-invasively staged groups (NIS). Multivariate analysis was performed to identify risk factors of pN2. Results A total of 201 patients were included in the study, 79 (39.3%) of whom were not invasively staged (NIS group) and 122 (60.7%) were invasively staged (IS group). Incidence of cN1 and mean PET/CT uptake was different among both groups. Prevalence of pN2 was similar in both groups (7.6% in NIS vs. 12.6% in IS; P>0.05). Median survival in IS-pN2 patients was 11 months longer than in NIS-pN2 group (33.6 vs. 22.5 months; P=0.245). cN1 emerged as the only a risk factor for pN2. Conclusions Invasive staging does not reduce the incidence of pN2. However, this finding could be biased because in our series cN1 patients were more often staged and cN1 has been detected as a risk factor for pN2. In addition patient better selection after invasive staging might have an impact on overall survival. To conclude, invasive mediastinal staging in intermediate risk patients for positive mediastinal nodes is justified.
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Affiliation(s)
- Marc Boada
- Thoracic Surgery Department, Respiratory Institute, Hospital Clínic de Barcelona, Barcelona, Spain.,Thoracic Oncology Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - David Sánchez-Lorente
- Thoracic Surgery Department, Respiratory Institute, Hospital Clínic de Barcelona, Barcelona, Spain.,Thoracic Oncology Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alejandra Libreros
- Thoracic Surgery Department, Respiratory Institute, Hospital Clínic de Barcelona, Barcelona, Spain.,Thoracic Oncology Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Carmen M Lucena
- Thoracic Oncology Unit, Hospital Clínic de Barcelona, Barcelona, Spain.,Pulmonology Department, Respiratory Institute, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Ramón Marrades
- Thoracic Oncology Unit, Hospital Clínic de Barcelona, Barcelona, Spain.,Pulmonology Department, Respiratory Institute, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Marcelo Sánchez
- Thoracic Oncology Unit, Hospital Clínic de Barcelona, Barcelona, Spain.,Radiology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Pilar Paredes
- Thoracic Oncology Unit, Hospital Clínic de Barcelona, Barcelona, Spain.,Nuclear Medicine Department, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Mario Serrano
- Pulmonology Department, Hospital de Mollet, Barcelona, Spain
| | - Angela Guirao
- Thoracic Surgery Department, Respiratory Institute, Hospital Clínic de Barcelona, Barcelona, Spain.,Thoracic Oncology Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Rudith Guzmán
- Thoracic Surgery Department, Respiratory Institute, Hospital Clínic de Barcelona, Barcelona, Spain.,Thoracic Oncology Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Núria Viñolas
- Thoracic Oncology Unit, Hospital Clínic de Barcelona, Barcelona, Spain.,Medical Oncology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Francesc Casas
- Thoracic Oncology Unit, Hospital Clínic de Barcelona, Barcelona, Spain.,Radiotherapy Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Carles Agustí
- Thoracic Oncology Unit, Hospital Clínic de Barcelona, Barcelona, Spain.,Pulmonology Department, Respiratory Institute, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Laureano Molins
- Thoracic Surgery Department, Respiratory Institute, Hospital Clínic de Barcelona, Barcelona, Spain.,Thoracic Oncology Unit, Hospital Clínic de Barcelona, Barcelona, Spain.,Nuclear Medicine Department, Hospital Clínic de Barcelona, Barcelona, Spain
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Brascia D, De Iaco G, Schiavone M, Panza T, Signore F, Geronimo A, Sampietro D, Montrone M, Galetta D, Marulli G. Resectable IIIA-N2 Non-Small-Cell Lung Cancer (NSCLC): In Search for the Proper Treatment. Cancers (Basel) 2020; 12:cancers12082050. [PMID: 32722386 PMCID: PMC7465235 DOI: 10.3390/cancers12082050] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/18/2020] [Accepted: 07/21/2020] [Indexed: 12/25/2022] Open
Abstract
Locally advanced non-small cell lung cancer accounts for one third of non-small cell lung cancer (NSCLC) at the time of initial diagnosis and presents with a wide range of clinical and pathological heterogeneity. To date, the combined multimodality approach involving both local and systemic control is the gold standard for these patients, since occult distant micrometastatic disease should always be suspected. With the rapid increase in treatment options, the need for an interdisciplinary discussion involving oncologists, surgeons, radiation oncologists and radiologists has become essential. Surgery should be recommended to patients with non-bulky, discrete, or single-level N2 involvement and be included in the multimodality treatment. Resectable stage IIIA patients have been the subject of a number of clinical trials and retrospective analysis, discussing the efficiency and survival benefits on patients treated with the available therapeutic approaches. However, most of them have some limitations due to their retrospective nature, lack of exact pretreatment staging, and the involvement of heterogeneous populations leading to the awareness that each patient should undergo a tailored therapy in light of the nature of his tumor, its extension and his performance status.
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Affiliation(s)
- Debora Brascia
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
| | - Giulia De Iaco
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
| | - Marcella Schiavone
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
| | - Teodora Panza
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
| | - Francesca Signore
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
| | - Alessandro Geronimo
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
| | - Doroty Sampietro
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
| | - Michele Montrone
- Medical Thoracic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70121 Bari, Italy; (M.M.); (D.G.)
| | - Domenico Galetta
- Medical Thoracic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70121 Bari, Italy; (M.M.); (D.G.)
| | - Giuseppe Marulli
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
- Correspondence: or
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Feasibility of Surgical Resection After Induction Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitor Therapy for N2 Lung Adenocarcinomas. Ann Thorac Surg 2020; 111:290-295. [PMID: 32569671 DOI: 10.1016/j.athoracsur.2020.04.133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 03/20/2020] [Accepted: 04/23/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Prognosis of patients with stage IIIA-N2 lung adenocarcinoma is still not optimistic. The aim of this study was to evaluate safety, feasibility, and outcomes of surgery after induction epidermal growth factor receptor-tyrosine kinase inhibitor therapy in a clinical trial setting. METHODS Fourteen patients with IIIA-N2 lung adenocarcinoma and epidermal growth factor receptor mutation received erlotinib induction followed by surgery in a phase II clinical trial. Perioperative outcomes and survival results were compared with a control group of 15 patients receiving neoadjuvant chemotherapy during the same time period. RESULTS Thirteen patients showed partial response to induction, whereas 16 patients remained stable. Serum carcinoembryonic antigen level in the erlotinib group was significantly higher than in the chemotherapy group before treatment but was reduced to similar levels after induction. Operation time, blood loss, resection extents, complete resection rates, postoperative drainage, complication rates, and length of hospital stay were all comparable between the 2 groups. Thoracoscopic resection was accomplished in 78.6% of patients in the erlotinib group and 80.0% of patients in the chemotherapy group (P = .924) but was higher in patients who responded to induction than those who did not (92.3% vs 68.8%, P = .119). A resection extent greater than lobectomy and incomplete resections were only seen in stable disease after induction. No significant difference was detected in 1-year and 3-year overall or disease-free survivals between the 2 groups. CONCLUSIONS Pulmonary resection is safe and feasible after induction treatment with erlotinib for stage IIIA-N2 lung adenocarcinomas. Better surgical and oncologic outcomes may be expected in patients who respond to effective induction therapies.
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Xi J, Du Y, Hu Z, Liang J, Bian Y, Chen Z, Sui Q, Zhan C, Li M, Guo W. Long-term outcomes following neoadjuvant or adjuvant chemoradiotherapy for stage I-IIIA non-small cell lung cancer: a propensity-matched analysis. J Thorac Dis 2020; 12:3043-3056. [PMID: 32642227 PMCID: PMC7330800 DOI: 10.21037/jtd-20-898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background This study aimed to evaluate the long-term survival outcomes of patients undergoing neoadjuvant chemoradiotherapy or adjuvant chemoradiotherapy for T1-4N0-1M0 disease. Methods Patients with pT1-4N0-1M0 between 2010 and 2015 who received pre- or postoperative (R0 resection) chemoradiotherapy were identified. The exclusion criteria included N2 or M1 disease, immunotherapy, and targeted therapy. The staging was recalculated according to the new 8th edition TNM classification. Survival and predictors were assessed using Kaplan-Meier and multivariate Cox proportional-hazards model. Propensity-score matching with a ratio of 2:1 was performed to reduce bias in various clinicopathological factors. Results Of the 1,769 patients who met the inclusion criteria, 407 and 814 were included in the neoadjuvant and adjuvant chemoradiotherapy group, respectively, after propensity-score matching. The 5-year overall survival (OS) and cancer-specific survival (CSS) were 38.1% and 40.0% for neoadjuvant chemoradiotherapy and 26.3% and 26.5% for adjuvant chemoradiotherapy, respectively [P<0.0001, hazard ratio (HR): 0.7418, 95% confidence interval (CI): 0.6434-0.8553; P<0.0001, HR: 0.7444, 95% CI: 0.6454-0.8587)]. When stratified by stage, stage IIA (P=0.4166, HR: 0.8575, 95% CI: 0.5917-1.243) and IIIA (P=0.0740, HR: 0.7687, 95% CI: 0.5748-1.028) did not show improved 5-year OS in patients receiving neoadjuvant chemoradiotherapy. When stratified by age, similar trends were observed for patients aged more than 75 years. The multivariable analysis showed a significant association of neoadjuvant chemoradiotherapy with better survival. Conclusions Neoadjuvant chemoradiotherapy might improve the long-term survival of patients with stage I-IIIA non-small cell lung cancer (NSCLC). For patients aged more than 75 years, neoadjuvant chemoradiotherapy was not associated with an improvement in survival.
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Affiliation(s)
- Junjie Xi
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yajing Du
- Center for Tumor Diagnosis and Therapy, Jinshan Hospital, Fudan University, Shanghai, China
| | - Zhengyang Hu
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiaqi Liang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yunyi Bian
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhencong Chen
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qihai Sui
- Eight-Year Program Clinical Medicine, Shanghai Medical College, Fudan University, Shanghai, China
| | - Cheng Zhan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ming Li
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Weigang Guo
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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Neoadjuvant atezolizumab and chemotherapy in patients with resectable non-small-cell lung cancer: an open-label, multicentre, single-arm, phase 2 trial. Lancet Oncol 2020; 21:786-795. [PMID: 32386568 DOI: 10.1016/s1470-2045(20)30140-6] [Citation(s) in RCA: 369] [Impact Index Per Article: 92.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/07/2020] [Accepted: 02/17/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Approximately 25% of all patients with non-small-cell lung cancer present with resectable stage IB-IIIA disease, and although perioperative chemotherapy is the standard of care, this treatment strategy provides only modest survival benefits. On the basis of the activity of immune checkpoint inhibitors in metastatic non-small-cell lung cancer, we designed a trial to test the activity of the PD-L1 inhibitor, atezolizumab, with carboplatin and nab-paclitaxel given as neoadjuvant treatment before surgical resection. METHODS This open-label, multicentre, single-arm, phase 2 trial was done at three hospitals in the USA. Eligible patients were aged 18 years or older and had resectable American Joint Committee on Cancer-defined stage IB-IIIA non-small-cell lung cancer, an Eastern Cooperative Oncology Group performance status of 0-1, and a history of smoking exposure. Patients received neoadjuvant treatment with intravenous atezolizumab (1200 mg) on day 1, nab-paclitaxel (100 mg/m2) on days 1, 8, and 15, and carboplatin (area under the curve 5; 5 mg/mL per min) on day 1, of each 21-day cycle. Patients without disease progression after two cycles proceeded to receive two further cycles, which were then followed by surgical resection. The primary endpoint was major pathological response, defined as the presence of 10% or less residual viable tumour at the time of surgery. All analyses were intention to treat. This study is registered with ClinicalTrials.gov, NCT02716038, and is ongoing but no longer recruiting participants. FINDINGS Between May 26, 2016, and March 1, 2019, we assessed 39 patients for eligibility, of whom 30 patients were enrolled. 23 (77%) of these patients had stage IIIA disease. 29 (97%) patients were taken into the operating theatre, and 26 (87%) underwent successful R0 resection. At the data cutoff (Aug 7, 2019), the median follow-up period was 12·9 months (IQR 6·2-22·9). 17 (57%; 95% CI 37-75) of 30 patients had a major pathological response. The most common treatment-related grade 3-4 adverse events were neutropenia (15 [50%] of 30 patients), increased alanine aminotransferase concentrations (two [7%] patients), increased aspartate aminotransferase concentration (two [7%] patients), and thrombocytopenia (two [7%] patients). Serious treatment-related adverse events included one (3%) patient with grade 3 febrile neutropenia, one (3%) patient with grade 4 hyperglycaemia, and one (3%) patient with grade 2 bronchopulmonary haemorrhage. There were no treatment-related deaths. INTERPRETATION Atezolizumab plus carboplatin and nab-paclitaxel could be a potential neoadjuvant regimen for resectable non-small-cell lung cancer, with a high proportion of patients achieving a major pathological response, and manageable treatment-related toxic effects, which did not compromise surgical resection. FUNDING Genentech and Celgene.
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Shin S, Kim HK, Cho JH, Choi YS, Kim K, Kim J, Zo JI, Sun JM, Ahn MJ, Park K, Pyo H, Ahn YC, Shim YM. Adjuvant therapy in stage IIIA-N2 non-small cell lung cancer after neoadjuvant concurrent chemoradiotherapy followed by surgery. J Thorac Dis 2020; 12:2602-2613. [PMID: 32642168 PMCID: PMC7330356 DOI: 10.21037/jtd.2020.03.23] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background This study aimed to determine whether adjuvant therapy improves survival in patients with stage IIIA-N2 non-small cell lung cancer (NSCLC) after neoadjuvant concurrent chemoradiotherapy (CCRT) followed by surgery. Methods We retrospectively reviewed 467 consecutive patients with stage IIIA-N2 NSCLC who received neoadjuvant CCRT followed by surgery between 2004 and 2013. From these, we identified 398 eligible patients and their clinical outcomes were compared according to whether adjuvant therapy was provided. Results In total, 296 patients (74%) received adjuvant therapy consisting of chemotherapy alone (n=71) radiotherapy alone (n=118) and both chemotherapy and radiotherapy (n=107). Adjuvant therapy was not given to remaining 102 patients. Patients who receiving adjuvant therapy were significantly younger (P=0.001), and predominantly male (P=0.014) compared to patients who did not receive adjuvant therapy. Regarding to the pathologic response, the adjuvant therapy group had a significantly poor pathologic response. However, the 5-year overall survival (OS) rate did not significantly differ between the groups (adjuvant therapy group, 52.9%; no adjuvant therapy group, 54.9%; P=0.369). After adjusting for age, sex, type of operation, cell type and yp stage, adjuvant therapy was significantly associated with better OS (hazard ratio =0.59; 95% CI, 0.38–0.92; P=0.019) and disease free survival (hazard ratio =0.62; 95% CI, 0.44–0.87; P=0.006). Conclusions Our data indicate that adjuvant therapy is more often given to patients with poor pathologic findings. Adjuvant treatment after trimodal therapy is a significant predictor of survival after adjustment of clinical variables.
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Affiliation(s)
- Sumin Shin
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Soo Choi
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwhanmien Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jhingook Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Ill Zo
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Mu Sun
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myung-Ju Ahn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keunchil Park
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hongryull Pyo
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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The top 100 cited articles in lung cancer - a bibliometric analysis. Contemp Oncol (Pozn) 2020; 24:17-28. [PMID: 32514234 PMCID: PMC7265956 DOI: 10.5114/wo.2020.94725] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/05/2020] [Indexed: 12/19/2022] Open
Abstract
Aim of the study To analyze the 100 most cited lung cancer articles published in biomedical literature in the last 44 years. We pointed out developments in lung cancer and aimed to create convenient access for the researchers of this dynamic field. Material and methods We accessed the WoS database (accessed: 15.07.2019) using the keyword “lung cancer” between 1975 and 2019. The top 100 cited articles were analyzed by topic, journal, author, year, institution, level of evidence, adjusted citation index and also the correlations between citation, adjusted citation index, impact factor and length of time since publication. Results A total of 240,701 eligible articles were identified and we chose the top 100 articles cited in the field of lung cancer. The mean number of citations for these articles was 1879.82 ±1264.78. The most cited article was (times cited: 7751) a study by Lynch et al. The New England Journal of Medicine (NEJM) made the greatest contribution to the top 100 list with 32 articles, and the most cited article also originated from NEJM. The highest number of citations was seen in 2017 with 18,393 citations while the highest number of publications was seen in 2005 with 12 publications. Conclusions Oncology is a developing field and we have seen the evolution in this area through the treatment of lung cancer in recent years. The first 100 articles in our analysis not only reflect the landmark articles with the greatest impact on lung cancer research, but also acknowledge the most productive authors and institutions that have contributed to the list with their articles.
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Validation of the Proposed cN2 Subclassification in the Eighth Edition of the IASLC Staging System: A Prospective Phase II Multicenter Study. JTO Clin Res Rep 2020; 1:100019. [PMID: 34589926 PMCID: PMC8474189 DOI: 10.1016/j.jtocrr.2020.100019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 02/11/2020] [Indexed: 12/24/2022] Open
Abstract
Introduction Surgery for N2 stage IIIA NSCLC is not recommended in major guidelines. Nevertheless, it has been noted that single-station N2 may have a better prognosis than multistation N2 and that surgery can be performed as the main therapeutic option. Methods We conducted a prospective phase II study for single-station clinical N2 (cN2) NSCLC to evaluate the efficacy and safety of surgical resection without induction therapy. Complete resection with lobectomy, bilobectomy, or pneumonectomy followed by ipsilateral mediastinal lymphadenectomy was performed in 32 of 34 enrolled patients, whereas the remaining two patients underwent incomplete resection. Three-quarters of the patients underwent subsequent adjuvant chemotherapy. Results The 5-year overall survival rate was 58.5% (95% confidence interval: 41.9–75.4) for all 34 patients, and eight patients (23.5%) with pN0 or pN1 seemed to have been enrolled. The 5-year overall survival rates for single-station cN2 without and with hilar node enlargement were 81.3% and 37.5%, respectively (p = 0.025). Surgical mortality was 0% for all, and no considerable perioperative complications were noted; however, two patients died of interstitial pneumonia and unknown cause within 3 months after surgical resection. Conclusions This is the very first prospective study on the surgical approach for cN2 NSCLC, and our result partially validated the proposed classification of the N descriptor in the new staging system. The treatment for single-station cN2 without hilar node enlargement would better if it were similar to that for cN1 disease. Induction chemotherapy or chemoradiotherapy may not be needed for such an entity.
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Xiong L, Lou Y, Bai H, Li R, Xia J, Fang W, Zhang J, Han-Zhang H, Lizaso A, Li B, Gu A, Han B. Efficacy of erlotinib as neoadjuvant regimen in EGFR-mutant locally advanced non-small cell lung cancer patients. J Int Med Res 2019; 48:300060519887275. [PMID: 31885349 PMCID: PMC7607055 DOI: 10.1177/0300060519887275] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background The optimal neoadjuvant regimen for locally advanced resectable non-small cell lung cancer (NSCLC) remains controversial. EGFR inhibitors have significantly improved survival in patients with EGFR-mutant advanced NSCLC. However, their efficacy in neoadjuvant settings, particularly for treating locally advanced NSCLC, remains unclear. We compared the clinical benefits of chemotherapy and erlotinib as neoadjuvant therapy for stage IIIA NSCLC. Method Thirty-one treatment-naïve Chinese patients with stage IIIA NSCLC were enrolled. Patients without EGFR mutation received cisplatin-based doublet chemotherapy (n = 16; N-chemo group) while EGFR-mutant patients received erlotinib (n = 15; N-TKI group) as neoadjuvant therapy. Results After completing neoadjuvant treatment, 12 and 8 patients from the N-TKI and N-chemo groups underwent surgery, respectively. Our data revealed that patients who received erlotinib had a marginally better clinical objective response rate (67% vs. 19%), pathological response rate (67% vs. 38%), and overall survival (51.0 months vs. 20.9 months) compared with those who received chemotherapy. Furthermore, patients in the N-TKI group had a significantly greater reduction in tumor diameter, serum carcinoembryonic level, and maximum allelic fraction. Conclusion Our findings demonstrate that erlotinib is an effective neoadjuvant regimen in patients with EGFR-mutant locally advanced NSCLC, paving the way for its extended use in neoadjuvant settings. [ClinicalTrials.gov identifier: NCT01217619]
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Affiliation(s)
- Liwen Xiong
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Yuqing Lou
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Hao Bai
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Rong Li
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Jinjing Xia
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Jie Zhang
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Han Han-Zhang
- Burning Rock Biotech, Guangzhou, People's Republic of China
| | - Analyn Lizaso
- Burning Rock Biotech, Guangzhou, People's Republic of China
| | - Bing Li
- Burning Rock Biotech, Guangzhou, People's Republic of China
| | - Aiqin Gu
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Baohui Han
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
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73
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Rice JD, Heidel J, Trivedi JR, van Berkel VH. Optimal Surgical Timing After Neoadjuvant Therapy for Stage IIIa Non-Small Cell Lung Cancer. Ann Thorac Surg 2019; 109:842-847. [PMID: 31756320 DOI: 10.1016/j.athoracsur.2019.09.076] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 09/13/2019] [Accepted: 09/27/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Patients with clinically/pathologically diagnosed stage IIIa non-small cell lung cancer (NSCLC) considered for surgery are recommended to undergo neoadjuvant chemotherapy with or without radiation. The timing of an operation after therapy is not standardized; therefore, we investigated the timing of intervention after neoadjuvant therapy and the impact on outcomes in this demographic. METHODS The National Cancer Database was queried between 2010 and 2015 for patients with clinical/pathologic stage IIIa NSCLC. Patients were then divided into short (<77 days), mid (77-114 days), and long delay (>114 days) groups based on interquartile values. These groups were then compared for age, race, gender, insurance type, Charlson-Deyo score, length of stay, readmission rate, and overall survival based on timing of operation. RESULTS There were 31,357 patients with clinical/pathologic stage IIIa NSCLC, and 5946 patients underwent surgical intervention. Preoperatively 3593 patients underwent chemoradiotherapy, 2185 underwent chemotherapy only, and 168 received radiation alone. The short, mid, and long delay groups were clinically and statistically similar in age, gender, insurance type, comorbidity index, treating facility type, and distance from home. Long delay groups had larger tumor size compared with other groups. Postoperative length of stay, rates of 30-day readmission, and 30- and 90-day mortality were similar across all groups. Cox modeling demonstrated a significant difference in survival when patients underwent earlier operative intervention compared with late operative intervention and when patients received chemoradiation compared with chemotherapy alone. Short, mid, and long delay group 1-year survivals were 82%, 83%, and 80% and 3-year survival 59%, 58%, and 52%, respectively (P = .0003). CONCLUSIONS The delay in surgical resection of stage IIIa NSCLC is not associated increased early mortality; however, it is associated with worse 3-year postresection survival.
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Affiliation(s)
- Jonathan D Rice
- Department of Cardiovascular and Thoracic Surgery, The University of Louisville School of Medicine, Louisville, Kentucky
| | - Justin Heidel
- Department of Cardiovascular and Thoracic Surgery, The University of Louisville School of Medicine, Louisville, Kentucky
| | - Jaimin R Trivedi
- Department of Cardiovascular and Thoracic Surgery, The University of Louisville School of Medicine, Louisville, Kentucky
| | - Victor H van Berkel
- Department of Cardiovascular and Thoracic Surgery, The University of Louisville School of Medicine, Louisville, Kentucky.
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74
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Zamora AK, Kim AW. Driving the discussion about the greater propensity for doing better with neoadjuvant chemotherapy for non-small cell lung cancer. J Thorac Dis 2019; 11:E174-E177. [PMID: 31737332 DOI: 10.21037/jtd.2019.09.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Abigail K Zamora
- Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Anthony W Kim
- Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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75
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Jin K, Hu Q, Xu J, Wu C, Hsin MK, Zirafa CC, Novoa NM, Bongiolatti S, Cerfolio RJ, Shen J, Ma D. The 100 most cited articles on thoracic surgery management of lung cancer. J Thorac Dis 2019; 11:4886-4903. [PMID: 31903279 DOI: 10.21037/jtd.2019.11.14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Ke Jin
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 317000, China
| | - Quanteng Hu
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 317000, China
| | - Jianfeng Xu
- Department of Cardiothoracic Surgery, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing 312000, China
| | - Chunlei Wu
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 317000, China
| | - Michael K Hsin
- Department of Cardiothoracic Surgery, Queen Mary Hospital, Hong Kong, China.,Department of Medicine, Hong Kong University, Hong Kong, China
| | - Carmelina C Zirafa
- Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, Pisa, Italy
| | - Nuria M Novoa
- General Thoracic Surgery Service, University Hospital of Salamanca and Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - Stefano Bongiolatti
- Thoracic Surgery Unit, University Hospital Careggi, Largo Brambilla, 1, 50134, Florence, Italy
| | - Robert J Cerfolio
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, USA
| | - Jianfei Shen
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 317000, China
| | - Dehua Ma
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 317000, China
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76
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Maniwa T. The current only location-based nodal classification in NSCLC may be inadequate. J Thorac Dis 2019; 11:E131-E132. [PMID: 31559083 DOI: 10.21037/jtd.2019.08.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Tomohiro Maniwa
- Department of Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
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77
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Yi C, He Y, Xia H, Zhang H, Zhang P. Review and perspective on adjuvant and neoadjuvant immunotherapies in NSCLC. Onco Targets Ther 2019; 12:7329-7336. [PMID: 31564915 PMCID: PMC6735538 DOI: 10.2147/ott.s218321] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/14/2019] [Indexed: 12/26/2022] Open
Abstract
Postoperative patients have risk recurring, even for completed resected early stage non-small-cell lung cancer (NSCLC). To control the recurrence rate, neoadjuvant and adjuvant therapies have been applied widely in clinical practice; however, neoadjuvant and adjuvant immunotherapy clinical trials on NSCLC are still being explored. In this review, we summarized the research progress and outline the issues need to be solved on adjuvant and neoadjuvant immunotherapies in NSCLC.
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Affiliation(s)
- Chengxiang Yi
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, People's Republic of China.,Tongji University School of Medicine, Tongji University, Shanghai 200433, People's Republic of China
| | - Yayi He
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai 200433, People's Republic of China
| | - Haoran Xia
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, People's Republic of China
| | - Helin Zhang
- Department of Thoracic Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang City, People's Republic of China
| | - Peng Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, People's Republic of China
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78
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Chen Z, Shen S, Shi W, Jiang G, Wang X, Jian H, Zhou Z, Ding Z, Lu S. Intercalated combination of chemotherapy and erlotinib for stage IIIA non-small-cell lung cancer: a multicenter, open-label, single-arm, phase II study. Cancer Manag Res 2019; 11:6543-6552. [PMID: 31372055 PMCID: PMC6636178 DOI: 10.2147/cmar.s189287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 04/10/2019] [Indexed: 12/29/2022] Open
Abstract
Objective This multicenter, open-label, single-arm, phase II trial evaluated the efficacy and safety of an intercalated combination of erlotinib and gemcitabine/cisplatin or carboplatin in patients with stage IIIA non-small-cell lung cancer (NSCLC). Registration This trial is registered with ClinicalTrials.gov, number NCT01297101. Methods The primary endpoint was the objective response rate (ORR), which includes complete response (CR) and partial response (PR), assessed using RECIST version 1.0 in the intention-to-treat population. Adverse events (AEs) were graded by the Common Terminology Criteria for Adverse Events (CTCAE) version 3.0. Secondary endpoints included the disease control rate, disease-free survival (DFS), overall survival (OS), and safety. Between April 1, 2011, and July 31, 2014, 39 patients with stage IIIA NSCLC received two cycles of intercalated use of erlotinib with gemcitabine/cisplatin or carboplatin. Results Eighteen patients (46.15%) achieved a PR and no patient achieved a pathologic CR, resulting in an ORR of 46.15% (95% CI 30-63%). Median DFS was 20 months (95% CI 5.26-50.61) and median OS was 25 months (95% CI 15.57-33.39). Patients with EGFR mutations (n=7) had a higher ORR than those with wild-type EGFR (n=9) (85.71% vs 55.56%, P=0.00). Most AEs were CTCAE grade 1 or 2; there were no cases of increased hematologic toxicity or erlotinib-emergent interstitial lung disease observed. Conclusion Two cycles of intercalated neoadjuvant therapy with erlotinib and gemcitabine/cisplatin or carboplatin were effective and safe for patients with stage IIIA NSCLC. This approach should be further explored in larger randomized controlled trials given the lack of a consensus about the best treatment for stage IIIA NSCLC.
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Affiliation(s)
- Zhiwei Chen
- Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, People's Republic of China
| | - Shengping Shen
- Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, People's Republic of China
| | - Wenbo Shi
- Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, People's Republic of China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, People's Republic of China
| | - Xin Wang
- Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Hong Jian
- Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, People's Republic of China
| | - Zhen Zhou
- Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, People's Republic of China
| | - Zhengping Ding
- Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, People's Republic of China
| | - Shun Lu
- Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, People's Republic of China
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79
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Tsunezuka H, Inoue M. Treatment rationale and design of the induction chemotherapy and adjuvant thoracic radiation in resectable N2-3A/3B non-small cell lung cancer (ICAT) study. Medicine (Baltimore) 2019; 98:e16298. [PMID: 31277165 PMCID: PMC6635234 DOI: 10.1097/md.0000000000016298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The optimal treatment strategy for stage N2-3A/3B non-small cell lung cancer (NSCLC) remains controversial owing to its heterogeneity. Although multimodal therapy is considered the standard therapeutic approach for stage N2-3A/3B resectable NSCLC patients, the optimal combination strategy still needs to be clarified. PATIENTS AND METHODS In total, 25 male and female patients aged between 20 and 75 years with stage N2-3A/3B resectable NSCLC will be included. Eligible patients will undergo tri-modality therapy comprising induction chemotherapy (3 cycles of combination therapy with carboplatin and nab-paclitaxel), followed by surgery and postoperative radiotherapy. Recruitment was commenced in April 2017, with a planned last follow-up in March 2024. As of May 2019, 1 subject has been enrolled. The primary endpoint is the treatment completion rate. The secondary endpoints are objective response rate (ORR) of induction chemotherapy, treatment-related adverse event, recurrence-free survival (RFS) time, and overall survival (OS) time. RFS and OS time will be calculated as the time from this study registration to first recurrence and all-cause death, respectively. ETHICS AND DISSEMINATION The protocol was approved by the institutional review boards of Kyoto Prefectural University of Medicine and all the participating hospitals. Written informed consent was obtained from all patients before registration, in accordance with the Declaration of Helsinki. The study results will be disseminated via publication in peer-reviewed journals. TRIAL REGISTRATION Trial registration number UMIN000025010 and jRCT1051180028.
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80
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Lee C, Guel DA, Weksler B. Is there a role for upfront surgery in patients with N2 disease and good prognostic features? J Thorac Dis 2019; 11:S1199-S1201. [PMID: 31245084 DOI: 10.21037/jtd.2019.03.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Candice Lee
- Division of Thoracic Surgery, Department of Thoracic and Cardiovascular Surgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | - David A Guel
- Division of Thoracic Surgery, Department of Thoracic and Cardiovascular Surgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Benny Weksler
- Division of Thoracic Surgery, Department of Thoracic and Cardiovascular Surgery, Allegheny General Hospital, Pittsburgh, PA, USA
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81
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Multidisciplinary consensus statement on the clinical management of patients with stage III non-small cell lung cancer. Clin Transl Oncol 2019; 22:21-36. [PMID: 31172444 DOI: 10.1007/s12094-019-02134-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 05/11/2019] [Indexed: 12/17/2022]
Abstract
Stage III non-small cell lung cancer (NSCLC) is a very heterogeneous disease that encompasses patients with resected, potentially resectable and unresectable tumours. To improve the prognostic capacity of the TNM classification, it has been agreed to divide stage III into sub-stages IIIA, IIIB and IIIC that have very different 5-year survival rates (36, 26 and 13%, respectively). Currently, it is considered that both staging and optimal treatment of stage III NSCLC requires the joint work of a multidisciplinary team of expert physicians within the tumour committee. To improve the care of patients with stage III NSCLC, different scientific societies involved in the diagnosis and treatment of this disease have agreed to issue a series of recommendations that can contribute to homogenise the management of this disease, and ultimately to improve patient care.
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82
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Berzenji L, Beckers P, Van Schil PE. Surgery for stage IIIA-N2 non-small cell lung cancer: the jury is still out! J Thorac Dis 2019; 11:S1153-S1156. [PMID: 31245070 DOI: 10.21037/jtd.2019.04.36] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Lawek Berzenji
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Belgium
| | - Paul Beckers
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Belgium
| | - Paul E Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Belgium
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83
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Tao X, Yuan C, Zheng D, Ye T, Pan Y, Zhang Y, Xiang J, Hu H, Chen H, Sun Y. Outcomes comparison between neoadjuvant chemotherapy and adjuvant chemotherapy in stage IIIA non-small cell lung cancer patients. J Thorac Dis 2019; 11:1443-1455. [PMID: 31179087 DOI: 10.21037/jtd.2019.03.42] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background A neoadjuvant chemotherapy (NCT) is a feasible second-option other than an adjuvant chemotherapy (ACT); however, no definite conclusions have been drawn about whether or not a NCT is associated with better clinical outcomes for IIIA non-small cell lung cancer (NSCLC) patients. Methods We reviewed 68 clinical IIIA NSCLC patients who received preoperative chemotherapy (NCT group), and 535 pathological IIIA NSCLC patients who received ACT after surgery (ACT group). After a 1:1 propensity score matching (PSM), we compared the relapse-free survival (RFS) and overall survival (OS) rates as the long-term clinical outcomes, and hospital stay, surgery duration, postoperative complications as the short-term clinical outcomes. To evaluate the predictive value of the NCT response, we also assessed the response evaluation criteria in solid tumors (RECIST) response to NCT. Results There was no significant difference in RFS or OS between the NCT group and ACT group (RFS: P=0.1138; OS: P=0.4234). On multivariate analysis, large cell lung carcinoma (P=0.0264), bilobectomy (P=0.0039) and clinical N2 stage (P=0.0309) were independent predictive factors of a worse OS. Short-term clinical outcomes including the hospital stay and postoperative complications had no statistically distinct difference between the ACT and NCT groups. Meanwhile, the OS of the partial response (PR) patients group was better than the stable disease/progressive disease (SD/PD) (P=0.0205) and ACT (P=0.0442) group, but none of the clinical features we tested was found to be a predictive factor for a PR response. Conclusions There was a non-significant difference between the long-term and short-term clinical outcomes of both NCT and ACT. The OS of PR patients was better than SD/PD and ACT, indicating that NCT response acts as a predictor for a higher long-term survival rate.
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Affiliation(s)
- Xiaoting Tao
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Chongze Yuan
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Difan Zheng
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Ting Ye
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Yunjian Pan
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Yawei Zhang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jiaqing Xiang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Hong Hu
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Haiquan Chen
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Yihua Sun
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
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84
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Induction Therapies Plus Surgery Versus Exclusive Radiochemotherapy in Stage IIIA/N2 Non-Small Cell Lung Cancer (NSCLC). Am J Clin Oncol 2019; 41:267-273. [PMID: 29116951 DOI: 10.1097/coc.0000000000000416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In spite of the growing body of data from prospective randomized clinical trials (PRCTs) and meta-analyses, the optimal treatment approach in patients with stage IIIA non-small cell lung cancer remains unknown. This review focuses on the available data directly confronting induction chemotherapy or induction radiochemotherapy (RT-CHT) when followed by surgery with exclusive RT-CHT. Seven PRCTs and 4 meta-analyses investigated this issue. In addition, numerous retrospective studies attempted to identify potential predictors and/or prognosticators that may have influenced the decision to offer surgery in a particular patient subgroup. Several retrospective studies also evaluated exclusive RT-CHT in this setting. There is not a single piece of the highest level of evidence (PRCT or MA) showing any advantage of induction therapies followed by surgery over exclusive RT-CHT with the former treatment option leading to significantly more morbidity and mortality. Although several studies attempted to identify patient subgroups favoring induction therapies followed by surgery, they have invariably been retrospective in nature, and their results have never been reproduced even in other retrospective setting. Furthermore, no PRCT investigated potential pretreatment patient and/or tumor-related predictors of surgical multimodality success. Exclusive RT-CHT achieves similar results to induction therapies followed by surgery but with less morbidity and mortality. This is accompanied with the finding that no pretreatment predictor exists to enable identification of even a subgroup of stage IIIA/pN2 patients benefiting from any surgical approach.
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85
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Romine PE, Martins RG, Eaton KD, Wood DE, Behnia F, Goulart BHL, Mulligan MS, Wallace SG, Kell E, Bauman JE, Patel SA, Vesselle HJ. Long term follow-up of neoadjuvant chemotherapy for non-small cell lung cancer (NSCLC) investigating early positron emission tomography (PET) scan as a predictor of outcome. BMC Cancer 2019; 19:70. [PMID: 30642285 PMCID: PMC6332837 DOI: 10.1186/s12885-019-5284-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 01/07/2019] [Indexed: 12/13/2022] Open
Abstract
Background Neoadjuvant chemotherapy is effective in improving survival of resectable NSCLC. Based on findings in the adjuvant and metastatic setting, FDG positron emission tomography (PET) scans may offer early prognostic or predictive value after one cycle of induction chemotherapy. Methods In this phase II non-randomized trial, patients with AJCC version 6 stage IB to IIIB operable NSCLC were treated with 3 cycles of cisplatin and pemetrexed neoadjuvant chemotherapy. Patients underwent FDG-PET scanning prior to and 18 to 21 days after the first cycle of chemotherapy. Investigators caring for patients were blinded to results, unless the scans showed evidence of disease progression. FDG-PET response was defined prospectively as a ≥ 20% decrease in the SUV of the primary lesion. Results Between October 2005 and February 2010, 25 patients enrolled. Fifty two percent were female, 88% white, and median age was 62 years. Histology was divided into adenocarcinoma 66%, not otherwise specified (NOS) 16%, squamous cell 12%, and large cell 4%. Stage distribution was: 16% IB, 4% IIB, and 79% IIIA. Treatment was well tolerated and only one patient had a grade 4 toxicity. The median follow up was 95 months. The 5 year progression free survival (PFS) and overall survival (OS) for the entire population were 54 and 67%, respectively. Eighteen patients had a baseline FDG-PET scan and a repeat scan at day 18–21 available for comparison. Ten patients (56%) were considered metabolic responders on the day 18–21 FDG-PET scan. Responders had a 5 year PFS and OS of 60 and 70%, respectively, while the percentage for non-responders was 63 and 75% (p = 0.96 and 0.85). Conclusions This phase II trial did not demonstrate that a PET scan after one cycle of chemotherapy can predict survival outcomes of patients with NSCLC treated with neoadjuvant chemotherapy. Trial registration NCT00227539 registered September 28th, 2005.
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Affiliation(s)
- Perrin E Romine
- University of Washington, School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Renato G Martins
- University of Washington, School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA.,Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA, 98109, USA
| | - Keith D Eaton
- University of Washington, School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA. .,Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA, 98109, USA.
| | - Douglas E Wood
- University of Washington, School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA.,Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA, 98109, USA
| | - Fatemeh Behnia
- University of Washington, School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Bernardo H L Goulart
- University of Washington, School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA.,Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA, 98109, USA
| | - Michael S Mulligan
- University of Washington, School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA.,Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA, 98109, USA
| | - Sarah G Wallace
- University of Washington, School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Elizabeth Kell
- Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA, 98109, USA
| | | | | | - Hubert J Vesselle
- University of Washington, School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA.,Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA, 98109, USA
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86
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Zhao Y, Wang W, Liang H, Yang CFJ, D'Amico T, Ng CSH, Liu CC, Petersen RH, Rocco G, Brunelli A, Liu J, He J, Huang W, Liang W, He J. The Optimal Treatment for Stage IIIA-N2 Non-Small Cell Lung Cancer: A Network Meta-Analysis. Ann Thorac Surg 2018; 107:1866-1875. [PMID: 30557543 DOI: 10.1016/j.athoracsur.2018.11.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 11/09/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND The optimal treatment for stage IIIA-N2 non-small cell lung cancer (NSCLC) is controversial. We aimed to address this important issue through a Bayesian network meta-analysis. METHODS We performed a search of electronic databases for randomized controlled trials comparing the following treatments: surgery, radiotherapy, chemotherapy, and their multiple combinations before March 25, 2018. Pooled data on overall survival and treatment-related deaths were analyzed within the Bayesian framework. RESULTS Eighteen eligible trials reporting 13 treatments were included. In terms of overall survival, neoadjuvant chemotherapy followed by surgery and adjuvant chemotherapy or radiotherapy, which tended to be consistent (hazard ratio [HR] 1.14, 95% credible interval [CrI] 0.21 to 5.93), ranked superior to other treatments. Notably, neoadjuvant chemotherapy followed by surgery and adjuvant radiotherapy was significantly more effective in prolonging survival than surgery alone (HR 0.38, 95% CrI 0.18 to 0.81), surgery plus adjuvant radiotherapy (HR 0.51, 95% CrI 0.29 to 0.92) and potentially surgery plus adjuvant chemotherapy (HR 0.49, 95% CrI 0.23 to 1.05). Overall, with 29% as the highest possibility of causing the fewest treatment-related deaths, neoadjuvant chemotherapy followed by surgery and adjuvant chemotherapy or radiotherapy was the safest treatment option. CONCLUSIONS Neoadjuvant chemotherapy followed by surgery and adjuvant chemotherapy or radiotherapy has the greatest possibility to be the optimal treatment with the best overall survival and fewest treatment-related deaths for stage IIIA-N2 NSCLC.
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Affiliation(s)
- Yi Zhao
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou Institute of Respiratory Disease, Guangzhou, China; State Key Laboratory of Respiratory Disease, Guangzhou, China; National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Wei Wang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou Institute of Respiratory Disease, Guangzhou, China; State Key Laboratory of Respiratory Disease, Guangzhou, China; National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Hengrui Liang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou Institute of Respiratory Disease, Guangzhou, China; State Key Laboratory of Respiratory Disease, Guangzhou, China; National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Chi-Fu Jeffrey Yang
- Section of General Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Thomas D'Amico
- Section of General Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Calvin S H Ng
- Department of Surgery, Prince of Wales Hospital, Hong Kong, China
| | - Chia-Chuan Liu
- Division of Thoracic Surgery, Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - René Horsleben Petersen
- Department of Cardiothoracic Surgery, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Gaetano Rocco
- Division of Thoracic Surgical Oncology, Istituto Nazionale Tumori, IRCCS, Fondazione Pascale, Naples, Italy
| | - Alessandro Brunelli
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, United Kingdom
| | - Jun Liu
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou Institute of Respiratory Disease, Guangzhou, China; State Key Laboratory of Respiratory Disease, Guangzhou, China; National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Jiaxi He
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou Institute of Respiratory Disease, Guangzhou, China; State Key Laboratory of Respiratory Disease, Guangzhou, China; National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Weizhe Huang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou Institute of Respiratory Disease, Guangzhou, China; State Key Laboratory of Respiratory Disease, Guangzhou, China; National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Wenhua Liang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou Institute of Respiratory Disease, Guangzhou, China; State Key Laboratory of Respiratory Disease, Guangzhou, China; National Clinical Research Center for Respiratory Disease, Guangzhou, China.
| | - Jianxing He
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou Institute of Respiratory Disease, Guangzhou, China; State Key Laboratory of Respiratory Disease, Guangzhou, China; National Clinical Research Center for Respiratory Disease, Guangzhou, China
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87
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Initial results of pulmonary resection after neoadjuvant nivolumab in patients with resectable non-small cell lung cancer. J Thorac Cardiovasc Surg 2018; 158:269-276. [PMID: 30718052 DOI: 10.1016/j.jtcvs.2018.11.124] [Citation(s) in RCA: 189] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 10/18/2018] [Accepted: 11/02/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE We conducted a phase I trial of neoadjuvant nivolumab, a monoclonal antibody to the programmed cell death protein 1 checkpoint receptor, in patients with resectable non-small cell lung cancer. We analyzed perioperative outcomes to assess the safety of this strategy. METHODS Patients with untreated stage I-IIIA non-small cell lung cancer underwent neoadjuvant therapy with 2 cycles of nivolumab (3 mg/kg), 4 and 2 weeks before resection. Patients underwent invasive mediastinal staging as indicated and post-treatment computed tomography. Primary study end points were safety and feasibility of neoadjuvant nivolumab followed by pulmonary resection. Data on additional surgical details were collected through chart review. RESULTS Of 22 patients enrolled, 20 underwent resection. One was unresectable; another had small cell histologic subtype. There were no delays to surgical resection. Median time from first treatment to surgery was 33 (range, 17-43) days. There were 15 lobectomies, 2 pneumonectomies, 1 bilobectomy, 1 sleeve lobectomy, and 1 wedge resection. Of 13 procedures attempted via a video-assisted thoracoscopic surgery or robotic approach, 7 (54%) required thoracotomy. Median operative time was 228 (range, 132-312) minutes; estimated blood loss was 100 (range, 25-1000) mL; length of hospital stay was 4 (range, 2-17) days. There was no operative mortality. Morbidity occurred in 10 of 20 patients (50%). The most common postoperative complication was atrial arrhythmia (6/20; 30%). Major pathologic response was identified in 9 of 20 patients (45%). CONCLUSIONS Neoadjuvant therapy with nivolumab was not associated with unexpected perioperative morbidity or mortality. More than half of the video-assisted thoracoscopic surgery/robotic cases were converted to thoracotomy, often because of hilar inflammation and fibrosis.
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88
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Kim MP, Correa AM, Hofstetter WL, Mehran RJ, Rice DC, Roth JA, Vaporciyan AA, Walsh GL, Erasmus JJ, Swisher SG. Occult stage IIIA-N2 patients have excellent overall survival with initial surgery. J Thorac Dis 2018; 10:6670-6676. [PMID: 30746212 DOI: 10.21037/jtd.2018.10.94] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Patients may be found to have stage IIIA-N2 at the final pathology after the initial surgery. We want to determine the survival rate in this unique group of patients. Methods We reviewed all patients who underwent surgical resection for lung cancer from 2000 to 2011 who had pathologic stage N2 without induction therapy. We determined the clinicopathologic characteristics and survival rate in this unique group of patients. Results A total of 101 patients met the inclusion criteria. The average age of the group was 65 years old with 53 (53%) females. The chest computed tomography (CT) scans showed 30 patients (30%) with mediastinal lymphadenopathy (>1 cm) and 13 (13%) with multistation disease. The positron emission tomography-computed tomography (PET-CT) showed 24 patients (24%) with N2 positive uptake. Invasive mediastinal staging prior to surgery occurred in 43 patients (43%). Eighty-four patients underwent a lobectomy (83%), 7 with bilobectomy (7%), and 10 with pneumonectomy (10%). The most common pathology was adenocarcinoma with 73 patients (72%) and the second most common was squamous cell carcinoma with 22 patients (22%). Most of the patients completed the adjuvant chemoradiation therapy (86%). The 5-year survival rate was 48% and the 10-year survival rate was 24%. Conclusions Pathologic stage IIIA-N2 non-small cell lung cancer (NSCLC) is a heterogeneous disease process with a very small group of patients undergoing initial surgery. Patients with occult stage IIIA-N2 who undergo initial surgery have an excellent overall survival rate.
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Affiliation(s)
- Min P Kim
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Division of Thoracic Surgery, Department of Surgery, Houston Methodist, Houston, Texas, USA
| | - Arlene M Correa
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Wayne L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Reza J Mehran
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David C Rice
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jack A Roth
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ara A Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Garrett L Walsh
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeremy J Erasmus
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Stephen G Swisher
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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89
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Current Status and Future Perspectives on Neoadjuvant Therapy in Lung Cancer. J Thorac Oncol 2018; 13:1818-1831. [DOI: 10.1016/j.jtho.2018.09.017] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/17/2018] [Accepted: 09/17/2018] [Indexed: 12/25/2022]
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90
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Maniwa T, Shintani Y, Okami J, Kadota Y, Takeuchi Y, Takami K, Yokouchi H, Kurokawa E, Kanzaki R, Sakamaki Y, Shiono H, Iwasaki T, Nishioka K, Kodama K, Okumura M. Upfront surgery in patients with clinical skip N2 lung cancer based on results of modern radiological examinations. J Thorac Dis 2018; 10:6828-6837. [PMID: 30746228 DOI: 10.21037/jtd.2018.10.115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Direct lymphatic drainage from a primary tumor to the right paratracheal or aortic window lymph nodes is often noted in pN2 disease. This multi-institutional retrospective study investigated the outcomes of upfront surgery in patients with clinical skip N2 disease (N2 disease without N1 disease) and a tumor in the right upper lobe or left upper segment based on results of modern radiological examinations, including positron emission tomography (PET). Methods We identified 143 patients with cN2 disease who underwent upfront surgery in 12 institutions under the Thoracic Surgery Study Group of Osaka University between January 2006 and December 2013. Among 143 patients, 94 who underwent PET were analyzed. We classified these patients into Group A (n=39; clinical skip N2 disease and a tumor in the right upper lobe or left upper segment) and Group B (n=55; other). Results The median follow-up was 56.5 months. Among the 94 patients, 50 (53.2%) had skip N2 disease and 65 (69.1%) had a tumor in the right upper lobe or left upper segment. The 5-year overall survival (OS) rates of the 94 patients with cN2 disease was 47.9%. The 5-year OS rates for the cN2pN0/1 (n=22) and cN2pN2 (n=70) groups were 74.9% and 41.2%, respectively (P=0.034). The univariate analysis of OS revealed no significant differences in age, sex, histology, carcinoembryonic antigen (CEA) level, tumor size, PET findings, and number of metastatic lymph nodes when these parameters were dichotomized. A significantly better 5-year OS rate was observed in Group A than in Group B (64.0% vs. 37.0%; P=0.039). The multivariate analysis of OS revealed that Group A was a significantly prognostic factor (P=0.030). Conclusions Patients with cN2 disease in Group A had a more favorable prognosis. Upfront surgery may be a treatment option for such selected patients with non-small lung cancer in the specific group.
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Affiliation(s)
- Tomohiro Maniwa
- Department of General Thoracic Surgery, Osaka International Cancer Center, Osaka, Japan.,Department of Thoracic Surgery, Yao Municipal Hospital, Osaka, Japan
| | - Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Jiro Okami
- Department of General Thoracic Surgery, Osaka International Cancer Center, Osaka, Japan
| | - Yoshihisa Kadota
- Department of Thoracic Surgery, Osaka Habikino Medical Center, Osaka, Japan
| | - Yukiyasu Takeuchi
- Department of Thoracic Surgery, Toneyama National Hospital, Osaka, Japan
| | - Koji Takami
- Department of Thoracic Surgery, Osaka National Hospital, Osaka, Japan
| | - Hideoki Yokouchi
- Department of Thoracic Surgery, Suita Municipal Hospital, Osaka, Japan
| | - Eiji Kurokawa
- Department of Thoracic Surgery, Minoh City Hospital, Osaka, Japan
| | - Ryu Kanzaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasushi Sakamaki
- Department of Thoracic Surgery, Osaka Police Hospital, Osaka, Japan
| | - Hiroyuki Shiono
- Department of Thoracic Surgery, Kindai University Nara Hospital, Nara, Japan
| | - Teruo Iwasaki
- Department of Thoracic Surgery, JCHO Osaka Hospital, Osaka, Japan
| | - Kiyonori Nishioka
- Department of Thoracic Surgery, Kinki Central Hospital, Hyogo, Japan
| | - Ken Kodama
- Department of Thoracic Surgery, Yao Municipal Hospital, Osaka, Japan
| | - Meinoshin Okumura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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91
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Wang X, Yin C, Su S, Li X, Wang C, Zhang C, Liu M. Long-term effects of neoadjuvant radiotherapy, adjuvant radiotherapy, and chemotherapy-only on survival of locally advanced non-small cell lung Cancer undergoing surgery: a propensity-matched analysis. BMC Cancer 2018; 18:1067. [PMID: 30400782 PMCID: PMC6219254 DOI: 10.1186/s12885-018-4900-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 10/03/2018] [Indexed: 02/07/2023] Open
Abstract
Background The optimal timing of radiotherapy (RT) with respect to surgery remains controversial for locally advanced non-small cell lung cancer (LA NSCLC) undergoing surgery and the long-term effect of neoadjuvant RT, adjuvant RT, and chemotherapy-only on survival is unknown. Methods A retrospective study with Greedy 5 → 1 Digit propensity score matching technique was performed for locally advanced NSCLC patients identified from the Surveillance, Epidemiology, and End Results (SEER) database during 2004 to 2012. Kaplan-Meier and the log-rank test were conducted to compare NSCLC-specific survival. Cox proportional hazards multivariable regression was performed to assess the impact of different treatment regimens on cancer-specific mortality after adjustment for demographic factors, histology type, tumor grade, tumor size, nodal stage, and extent of resection. Results One thousand, two hundred and seventy-eight locally advanced NSCLC patients undergoing surgery were identified after propensity matching. Cox regression analyses showed the risk of cancer-specific mortality is not significantly different among neoadjuvant RT, adjuvant RT, and chemotherapy-only. Subgroup analyses showed that for patients with T1/2 & N2/3, the surgery plus chemotherapy-only group showed markedly higher mortality risk (HR = 1.42, 95%CI:1.10–1.83) than the neoadjuvant RT group. Other risk factors include older age, higher tumor grade, larger tumor size, and greater lymph node involvement. Conclusions The findings of this study suggest that the benefit of additional neoadjuvant or adjuvant RT to chemotherapy may be linked to a proper selection of LA NSCLC patients who undergo surgery. The timing of radiotherapy should be decided on the premise of fully considering patients’ condition and the quality of life after treatment. Electronic supplementary material The online version of this article (10.1186/s12885-018-4900-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xinyu Wang
- Department of Biostatistics, Public Health College, Harbin Medical University, 157 Baojian Road, Harbin, Heilongjiang Province, 150081, People's Republic of China
| | - Chang Yin
- Information Centre, National Institute of Hospital Administration, Beijing, China
| | - Shaofei Su
- Department of Biostatistics, Public Health College, Harbin Medical University, 157 Baojian Road, Harbin, Heilongjiang Province, 150081, People's Republic of China
| | - Xi Li
- Department of Biostatistics, Public Health College, Harbin Medical University, 157 Baojian Road, Harbin, Heilongjiang Province, 150081, People's Republic of China
| | - Chao Wang
- Department of Biostatistics, Public Health College, Harbin Medical University, 157 Baojian Road, Harbin, Heilongjiang Province, 150081, People's Republic of China
| | - Chaoli Zhang
- Care Quality Control Office, Xi'an Jiaotong University Second Affiliated Hospital, Xi'an, China
| | - Meina Liu
- Department of Biostatistics, Public Health College, Harbin Medical University, 157 Baojian Road, Harbin, Heilongjiang Province, 150081, People's Republic of China.
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92
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Spicer JD, Shewale JB, Nelson DB, Mitchell KG, Bott MJ, Vallières E, Wilshire CL, Vaporciyan AA, Swisher SG, Jones DR, Darling GE, Sepesi B. Multimodality Therapy for N2 Non-Small Cell Lung Cancer: An Evolving Paradigm. Ann Thorac Surg 2018; 107:277-284. [PMID: 30227129 DOI: 10.1016/j.athoracsur.2018.07.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 06/09/2018] [Accepted: 07/09/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Induction chemoradiation for resectable N2 non-small cell lung cancer (NSCLC) is used with the intent to optimize locoregional control, whereas induction chemotherapy given in systemic doses is meant to optimally target potential distant disease. However, the optimal preoperative treatment regimen is still unknown and practice patterns continue to vary widely. We compared multiinstitutional oncologic outcomes for N2 NSCLC from 4 experienced lung cancer treatment centers. METHODS This collaborative retrospective study unites 4 major thoracic oncology centers. Patients with N2 NSCLC undergoing surgical resection after induction chemotherapy (CxT) or concurrent chemoradiation (CxRT) were included. Primary outcomes were overall and disease-free survival (OS and DFS). RESULTS 822 patients were identified (CxT = 662 and CxRT = 160). There were no differences in 5-year OS (CxT 39.9% versus CxRT 42.9%, p = 0.250) nor in DFS (CxT 28.7% versus 29.8%, p = 0.207). Recurrence rates (CxT 46.8% versus CxRT 51.6%, p = 0.282) and recurrence patterns were not significantly different (Local: CxT 9.8% versus CxRT 9.7%; and Distant: CxT 30.4% versus CxRT 33.1%, p = 0.764). There was no difference in perioperative mortality. In the analyses of patients who underwent pretreatment invasive mediastinal staging (n = 555), there were still no significant differences in OS (p = 0.341) and DFS (p = 0.455) between the 2 treatment strategies. CONCLUSIONS Both treatment strategies produce equivalent and better than expected outcomes compared with historical controls for N2 NSCLC, with no differences in recurrence patterns. How these conventional therapeutic strategies will compare with those involving immunotherapy combined with surgical locoregional disease control for N2 disease remains to be determined.
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Affiliation(s)
- Jonathan D Spicer
- Division of Thoracic Surgery, McGill University Health Centre, Montréal, Quebec, Canada.
| | - Jitesh B Shewale
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center (UTHealth) School of Public Health, Houston, Texas
| | - David B Nelson
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kyle G Mitchell
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Matthew J Bott
- Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Eric Vallières
- Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington
| | - Candice L Wilshire
- Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington
| | - Ara A Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen G Swisher
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David R Jones
- Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Gail E Darling
- Division of Thoracic Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | - Boris Sepesi
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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93
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Sanchez-Lorente D, Guzman R, Boada M, Guirao A, Carriel N, Molins L. N2 disease in non-small-cell lung cancer: straight to surgery? Future Oncol 2018; 14:13-16. [PMID: 29664353 DOI: 10.2217/fon-2017-0387] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The correct treatment for patients with non-small-cell lung cancer and ipsilateral mediastinal involvement (N2) remains a challenge. The heterogeneity of this group of patients has been shown, as well as many different prognostic factors, that will determine a specific management to each of them. Although the standard treatment is based on a multimodality therapy consisting of chemotherapy, radiotherapy and surgery, surgery is not always indicated. The selection of patients who are going to be operated, reminds being a key point of the treatment of this disease. Recent reports on operable N2 disease have been reviewed by our group in order to discuss surgery indications and when to bring it about, with the possibility to go straight to surgery.
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Affiliation(s)
| | - Rudith Guzman
- General Thoracic Surgery, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Marc Boada
- General Thoracic Surgery, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Angela Guirao
- General Thoracic Surgery, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Nicole Carriel
- General Thoracic Surgery, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Laureano Molins
- General Thoracic Surgery, Hospital Clinic of Barcelona, Barcelona, Spain
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94
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Making the Evidentiary Case for Universal Multidisciplinary Thoracic Oncologic Care. Clin Lung Cancer 2018; 19:294-300. [PMID: 29934139 DOI: 10.1016/j.cllc.2018.05.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 05/14/2018] [Indexed: 12/22/2022]
Abstract
The goal of this article is to provide an overview of the state of the evidence for, and challenges to, sustainable implementation of multidisciplinary thoracic oncology programs. Multidisciplinary care is much advocated by professional groups and makers of clinical guidelines, but little practiced. The gap between universal recommendation and scant evidence of practice suggests the existence of major barriers to program implementation. We examine 2 articles published in this issue of Clinical Lung Cancer to illustrate problems with the evidence base for multidisciplinary care. The inherent complexity of care delivery for the lung cancer patient drives near-universal advocacy for multidisciplinary care as a means of overcoming the heterogeneous quality and outcomes of patient care. However, the evidence to support this model of care delivery is poor. Challenges include the absence of a clear definition of "multidisciplinary care" in the literature, a consequent hodge-podge of poorly-defined examples of tested models, methodologically flawed studies, exemplified by the near-total absence of prospective studies examining this model of care delivery, and absence of scientifically sound dissemination and implementation studies, as well as cost-effectiveness studies. Against this background, we examined the results of a recent large single-institutional retrospective study suggesting the survival benefit of care within a colocated multidisciplinary lung cancer clinic, and an ambitious systematic review of existing literature on multidisciplinary cancer clinics. Better-quality evidence is still needed to establish the value of the multidisciplinary care concept. Such studies need to be prospective, use standardized definitions of multidisciplinary care, and provide clear information about program structure.
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95
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Abstract
Locally advanced (stage IIIA) non-small cell lung cancer (NSCLC) is confined to the chest, but requires more than surgery to maximize cure. Therapy given preoperatively is termed neoadjuvant, whereas postoperative therapy is termed adjuvant. Trimodality therapy (chemotherapy, radiation, and surgery) has become the standard treatment regimen for resectable, locally advanced NSCLC. During the past 2 decades, several prospective, randomized, and nonrandomized studies have explored various regimens for preoperative treatment of NSCLC. The evaluation of potential candidates with NSCLC for neoadjuvant therapy as well as the currently available therapeutic regimens are reviewed.
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Affiliation(s)
- Yifan Zheng
- Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Michael T Jaklitsch
- Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Raphael Bueno
- Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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96
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Tong S, Qin Z, Wan M, Zhang L, Cui Y, Yao Y. Induction chemoradiotherapy versus induction chemotherapy for potentially resectable stage IIIA (N2) non-small cell lung cancer: a systematic review and meta-analysis. J Thorac Dis 2018; 10:2428-2436. [PMID: 29850149 DOI: 10.21037/jtd.2018.04.24] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Non-small cell lung cancer (NSCLC) accounts for 85% to 90% of lung cancer cases. At diagnosis, around 30% of NSCLC patients are already at stage IIIA (N2). One standard treatment for this stage is induction chemotherapy followed by surgery, whether induction chemoradiotherapy is superior to induction chemotherapy remains uncertain. We therefore performed a systematic review and meta-analysis of published randomized control trials to evaluate the therapeutic efficacy and toxicity of induction chemoradiotherapy versus induction chemotherapy for potentially resectable stage IIIA (N2) NSCLC. Methods We systematically searched for relevant studies in PubMed, Embase, Web of Science and Cochrane Library from the inception of each database to September 10, 2017. The primary endpoints were objective response rate (ORR), pathological complete response (pCR) rate of mediastinal lymph nodes, toxicity (grade 3-4 adverse events, i.e., nausea and vomiting, infections, leukopenia and anemia), overall survival (OS) and progression-free survival (PFS). Statistical analyses were performed using Review Manager v5.3. Results Four studies, containing 461 patients in total, were included for meta-analysis. Our analyses suggest that compared with induction chemotherapy, induction chemoradiotherapy improved ORR [odds ratio (OR) =1.97, 95% confidence interval (CI): 1.25-3.10, P<0.05] and pCR rate of mediastinal lymph nodes (OR =1.97, 95% CI: 1.00-3.86, P=0.05); but it did not significantly improve OS [hazard ratio (HR) =0.91, 95% CI: 0.73-1.14, P=0.42] or PFS (HR =1.01, 95% CI: 0.81-1.26, P=0.91); also it did not exacerbate the toxicity. Conclusions Induction chemoradiotherapy may have limited value concerning tumor response and pCR of mediastinal lymph nodes. However, current evidence does not support that addition of radiotherapy to induction chemotherapy followed by surgery can bring significant benefits to operable stage IIIA (N2) NSCLC patients. More studies are required to draw a better conclusion.
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Affiliation(s)
- Shaodong Tong
- Department of Radiation Oncology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou Medical University, Xuzhou 221000, China.,Jiangsu Key Laboratory of Biological Therapies for Tumors, Xuzhou Medical University, Xuzhou 221000, China
| | - Zhaohui Qin
- School of Public Health, Xuzhou Medical University, Xuzhou 221000, China
| | - Minghui Wan
- Department of Radiation Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510260, China
| | - Longzhen Zhang
- Department of Radiation Oncology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou Medical University, Xuzhou 221000, China
| | - Yan Cui
- Leibniz Institute on Aging-Fritz Lipmann Institute, Jena, Germany
| | - Yuanhu Yao
- Department of Radiation Oncology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou Medical University, Xuzhou 221000, China
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97
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Watanabe SI, Nakagawa K, Suzuki K, Takamochi K, Ito H, Okami J, Aokage K, Saji H, Yoshioka H, Zenke Y, Aoki T, Tsutani Y, Okada M. Neoadjuvant and adjuvant therapy for Stage III non-small cell lung cancer. Jpn J Clin Oncol 2018; 47:1112-1118. [PMID: 29136212 DOI: 10.1093/jjco/hyx147] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 09/23/2017] [Indexed: 11/13/2022] Open
Abstract
The treatments for advanced non-small cell lung cancer (NSCLC) should control both local and microscopic systemic disease, because the 5-year survival of patients with Stage III NSCLC who underwent surgical resection alone has been dismal. One way to improve surgical outcome is the administration of chemotherapy before or after the surgical procedure. During the last two decades, many clinical studies have focused on developing optimal adjuvant or neoadjuvant chemotherapy regimens that can be combined with surgical treatment and/or radiotherapy. Based on the results of those clinical studies, multimodality therapy is considered to be an appropriate treatment approach for Stage IIIA NSCLC patients; although, optimal treatment strategies are still evolving. When N2 nodal involvement is discovered postoperatively, adjuvant cisplatin-based chemotherapy confers an overall survival benefit. The addition of postoperative radiotherapy might be considered for patients with nodal metastases. Although definitive chemoradiation remains a standard of care for cN2 NSCLC, alternative approaches such as induction chemotherapy or chemoradiotherapy and surgery can be considered for a selective group of patients. When surgical resection can be performed after induction therapy with low risk and a good chance of complete resection, the outcome may be optimal. The decision to proceed with resection after induction therapy must include a detailed preoperative pulmonary function evaluation as well as a critical intraoperative assessment of the feasibility of complete resection.
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Affiliation(s)
| | - Kazuo Nakagawa
- Department of Thoracic Surgery, National Cancer Center Hospital
| | - Kenji Suzuki
- Division of General Thoracic Surgery, Juntendo University Hospital, Tokyo
| | - Kazuya Takamochi
- Division of General Thoracic Surgery, Juntendo University Hospital, Tokyo
| | - Hiroyuki Ito
- Department of Thoracic Surgery, Kanagawa Cancer Center, Kanagawa
| | - Jiro Okami
- Department of Thoracic Surgery, Osaka International Cancer Institute, Osaka
| | - Keiju Aokage
- Division of Thoracic Surgery, National Cancer Center Hospital East, Chiba
| | - Hisashi Saji
- Department of Chest Surgery, St. Marianna University School of Medicine, Kanagawa
| | | | - Yoshitaka Zenke
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Komagome Hospital
| | - Tadashi Aoki
- Department of Thoracic Surgery, Niigata Cancer Center, Niigata
| | - Yasuhiro Tsutani
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
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98
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Jeremić B, Casas F, Dubinsky P, Gomez-Caamano A, Čihorić N, Videtic G, Igrutinovic I. Treatment-Related Predictive and Prognostic Factors in Trimodality Approach in Stage IIIA/N2 Non-Small Cell Lung Cancer. Front Oncol 2018. [PMID: 29527511 PMCID: PMC5829546 DOI: 10.3389/fonc.2018.00030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
While there are no established pretreatment predictive and prognostic factors in patients with stage IIIA/pN2 non-small cell lung cancer (NSCLC) indicating a benefit to surgery as a part of trimodality approach, little is known about treatment-related predictive and prognostic factors in this setting. A literature search was conducted to identify possible treatment-related predictive and prognostic factors for patients for whom trimodality approach was reported on. Overall survival was the primary endpoint of this study. Of 30 identified studies, there were two phase II studies, 5 “prospective” studies, and 23 retrospective studies. No study was found which specifically looked at treatment-related predictive factors of improved outcomes in trimodality treatment. Of potential treatment-related prognostic factors, the least frequently analyzed factors among 30 available studies were overall pathologic stage after preoperative treatment and UICC downstaging. Evaluation of treatment response before surgery and by pathologic tumor stage after induction therapy were analyzed in slightly more than 40% of studies and found not to influence survival. More frequently studied factors—resection status, degree of tumor regression, and pathologic nodal stage after induction therapy as well as the most frequently studied factor, the treatment (in almost 75% studies)—showed no discernible impact on survival, due to conflicting results. Currently, it is impossible to identify any treatment-related predictive or prognostic factors for selecting surgery in the treatment of patients with stage IIIA/pN2 NSCLC.
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Affiliation(s)
| | | | - Pavol Dubinsky
- University Hospital to East Slovakia Institute of Oncology, Kosice, Slovakia
| | | | - Nikola Čihorić
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Ivan Igrutinovic
- Faculty of Science, University of Kragujevac, Kragujevac, Serbia
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99
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Krantz SB, Mitzman B, Lutfi W, Kuchta K, Wang CH, Howington JA, Kim KW. Neoadjuvant Chemoradiation Shows No Survival Advantage to Chemotherapy Alone in Stage IIIA Patients. Ann Thorac Surg 2018; 105:1008-1016. [PMID: 29453000 DOI: 10.1016/j.athoracsur.2017.10.056] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 10/19/2017] [Accepted: 10/20/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND For operable patients with clinical stage IIIA non-small cell lung cancer, the optimum neoadjuvant treatment strategy remains unclear. Our aim was to compare perioperative and long-term outcomes for patients receiving neoadjuvant chemoradiotherapy (NCRT) versus neoadjuvant chemotherapy (NCT) alone. METHODS We queried the National Cancer Database to identify all patients with N2 and either T1-T2 non-small cell lung cancer who received either NCRT or NCT followed by lobectomy between 2006 and 2012. Patients with T3 tumors were excluded. A propensity match analysis was performed incorporating preoperative variables, and the incidence of postoperative complications, pathologic downstaging, and long-term survival were compared. RESULTS In all, 1,936 patients met criteria, 745 NCT and 1,191 NCRT. The NCRT patients were younger, less likely to be treated at an academic medical center, and more likely to have adenocarcinoma. After propensity matching, patients in the NCT group showed lower 30-day mortality (1.3% versus 2.9%) and 90-day mortality (2.9% versus 6.0%), and were more likely to undergo a minimally invasive resection (25.7% versus 14.1%). The NCRT patients were more likely to have a pathologic complete response (14.2% versus 4.0%) and to be N0 at the time of resection (45.2% versus 38.7%). In the multivariable analysis, NCRT patients were at a greater risk of mortality than NCT patients (hazard ratio 1.18, 95% confidence interval: 1.03 to 1.36). CONCLUSIONS In our cohort, combined neoadjuvant chemotherapy and radiation therapy was associated with improved pathologic downstaging but showed increased perioperative mortality with no improvement in long-term overall survival. For stage IIIA patients with smaller tumors without local invasion, chemotherapy alone may be the preferred neoadjuvant treatment.
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Affiliation(s)
- Seth B Krantz
- Department of Surgery, NorthShore University Health System, Evanston, Illinois; Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois.
| | - Brian Mitzman
- Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Waseem Lutfi
- Department of Surgery, NorthShore University Health System, Evanston, Illinois
| | - Kristine Kuchta
- Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, Illinois
| | - Chi-Hsiung Wang
- Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, Illinois
| | - John A Howington
- Department of Surgery, Saint Thomas Healthcare, Nashville, Tennessee
| | - Ki Wan Kim
- Department of Surgery, NorthShore University Health System, Evanston, Illinois; Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois
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100
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Vyfhuis MAL, Burrows WM, Bhooshan N, Suntharalingam M, Donahue JM, Feliciano J, Badiyan S, Nichols EM, Edelman MJ, Carr SR, Friedberg J, Henry G, Stewart S, Sachdeva A, Pickering EM, Simone CB, Feigenberg SJ, Mohindra P. Implications of Pathologic Complete Response Beyond Mediastinal Nodal Clearance With High-Dose Neoadjuvant Chemoradiation Therapy in Locally Advanced, Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2018; 101:445-452. [PMID: 29559292 DOI: 10.1016/j.ijrobp.2018.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/26/2018] [Accepted: 02/05/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE To determine, in a retrospective analysis of a large cohort of stage III non-small cell lung cancer patients treated with curative intent at our institution, whether having a pathologic complete response (pCR) influenced overall survival (OS) or freedom from recurrence (FFR) in patients who underwent definitive (≥60 Gy) neoadjuvant doses of chemoradiation (CRT). METHODS AND MATERIALS At our institution, 355 patients with locally advanced non-small cell lung cancer were treated with curative intent with definitive CRT (January 2000-December 2013), of whom 111 underwent mediastinal reassessment for possible surgical resection. Ultimately 88 patients received trimodality therapy. Chi-squared analysis was used to compare categorical variables. The Kaplan-Meier analysis was performed to estimate OS and FFR, with Cox regression used to determine the absolute hazards. RESULTS Using high-dose neoadjuvant CRT, we observed a mediastinal nodal clearance (MNC) rate of 74% (82 of 111 patients) and pCR rate of 48% (37 of 77 patients). With a median follow-up of 34.2 months (range, 3-177 months), MNC resulted in improved OS and FFR on both univariate (OS: hazard ratio [HR] 0.455, 95% confidence interval [CI] 0.272-0.763, P = .004; FFR: HR 0.426, 95% CI 0.250-0.726, P = .002) and multivariate analysis (OS: HR 0.460, 95% CI 0.239-0.699, P = .001; FFR: HR 0.455, 95% CI 0.266-0.778, P = .004). However, pCR did not independently impact OS (P = .918) or FFR (P = .474). CONCLUSIONS Mediastinal nodal clearance after CRT continues to be predictive of improved survival for patients undergoing trimodality therapy. However, a pCR at both the primary and mediastinum did not further improve survival outcomes. Future therapies should focus on improving MNC to encourage more frequent use of surgery and might justify use of preoperative CRT over chemotherapy alone.
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Affiliation(s)
- Melissa A L Vyfhuis
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland
| | - Whitney M Burrows
- Division of Thoracic Surgery, University of Maryland Medical Center, Baltimore, Maryland
| | - Neha Bhooshan
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland
| | - Mohan Suntharalingam
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland
| | - James M Donahue
- Division of Thoracic Surgery, Department of Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Josephine Feliciano
- Department of Hematology and Oncology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Shahed Badiyan
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Elizabeth M Nichols
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Martin J Edelman
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Shamus R Carr
- Division of Thoracic Surgery, University of Maryland Medical Center, Baltimore, Maryland
| | - Joseph Friedberg
- Division of Thoracic Surgery, University of Maryland Medical Center, Baltimore, Maryland
| | - Gavin Henry
- Division of Thoracic Surgery, University of Maryland Medical Center, Baltimore, Maryland
| | - Shelby Stewart
- Division of Thoracic Surgery, University of Maryland Medical Center, Baltimore, Maryland
| | - Ashutosh Sachdeva
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Edward M Pickering
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Charles B Simone
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland
| | - Steven J Feigenberg
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Pranshu Mohindra
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland.
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