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Oskarsdottir GN, Lampa E, Berglund A, Rosengren L, Ulvestad M, Boros M, Daumont MJ, Rault C, Emanuel G, Leal C, Schoemaker MJ, Wagenius G. Real-World Treatment Patterns and Survival Outcomes for Patients with Non-Metastatic Non-Small-Cell Lung Cancer in Sweden: A Nationwide Registry Analysis from the I-O Optimise Initiative. Cancers (Basel) 2024; 16:1655. [PMID: 38730607 PMCID: PMC11083854 DOI: 10.3390/cancers16091655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/16/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Non-small-cell lung cancer (NSCLC) is the leading cause of cancer-related death worldwide, with ~40-50% of patients diagnosed with non-metastatic disease (stages IA-IIIC). The treatment landscape is evolving rapidly as immunotherapies and targeted therapy are introduced in the non-metastatic setting, creating a need to assess patient outcomes prior to their introduction. This real-world study using Swedish National Lung Cancer Registry data examined outcomes (overall survival (OS) and time to next treatment or death (TTNTD)) and treatment patterns for adults diagnosed with non-metastatic NSCLC. Baseline characteristics and OS from diagnosis were described for all patients; OS, treatment patterns, and TTNTD from treatment start were described for the treatment subgroup (patients diagnosed from 2014 onwards), stratified by disease stage and initial treatment. OS and TTNTD were described using the Kaplan-Meier estimator. The overall population (2008-2019) included 17,433 patients; the treatment subgroup included 5147 patients. Median OS (interquartile range) overall ranged from 83.3 (31.6-165.3) months (stage I patients) to 10.4 (4.3-24.2) months (stage IIIB patients). Among the treatment subgroup, median OS and TTNTD were longest among patients receiving surgery versus other anticancer treatments. These findings provide a baseline upon which to evaluate the epidemiology of non-metastatic NSCLC as newer treatments are introduced.
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Affiliation(s)
- Gudrun N. Oskarsdottir
- Department of Respiratory Medicine and Allergology, Skåne University Hospital, V/O Hjärt- och Lungmedicin, 222 42 Lund, Sweden
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, 22 381 Lund, Sweden
| | - Erik Lampa
- Epistat AB, 753 30 Uppsala, Sweden; (E.L.); (A.B.)
| | | | - Linda Rosengren
- Medical Department Sweden, Bristol Myers Squibb, Hemvärnsgatan 9, 171 23 Solna, Sweden
| | - Maria Ulvestad
- Medical Department Nordics, Bristol Myers Squibb, Lysaker Torg 35, 1366 Lysaker, Norway;
| | - Miklos Boros
- Department of Cardiothoracic Surgery, Linköping University Hospital, 581 85 Linköping, Sweden;
| | - Melinda J. Daumont
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, 1420 Braine-L’Alleud, Belgium;
| | | | - Gabrielle Emanuel
- Real-World Data Analytics Markets, Bristol Myers Squibb, Uxbridge Business Park, Sanderson Road, Uxbridge UB8 1DH, UK;
| | | | | | - Gunnar Wagenius
- Department of Oncology-Pathology, Karolinska Institute, 141 86 Stockholm, Sweden;
- Thoracic Oncology Centre, The Cancer Theme, Karolinska University Hospital, 171 76 Stockholm, Sweden
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Rodriguez-Quintero JH, Kamel MK, Dawodu G, Elbahrawy M, Vimolratana M, Chudgar NP, Stiles BM. Underutilization of Systemic Therapy in Patients With NSCLC Undergoing Pneumonectomy: A Missed Opportunity for Survival. JTO Clin Res Rep 2023; 4:100547. [PMID: 37644968 PMCID: PMC10460993 DOI: 10.1016/j.jtocrr.2023.100547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/13/2023] [Accepted: 06/24/2023] [Indexed: 08/31/2023] Open
Abstract
Introduction Recent trials have reported promising results with the addition of immunotherapy to chemotherapy for patients with locally advanced NSCLC, but in practice, the proportion of patients who receive systemic therapy (ST) has historically been low. Underutilization of ST may be particularly apparent in patients undergoing pneumonectomy, in whom the physiologic insult and surgical complications may preclude adjuvant therapy (ADJ). We, therefore, evaluated the use of ST for patients with NSCLC undergoing pneumonectomy. Methods We queried the National Cancer Database, including all patients with NSCLC who underwent pneumonectomy between 2006 and 2018. Logistic regression was used to identify associations with ST and neo-ADJ (NEO). Overall survival was compared after propensity score matching (1:1) patients undergoing ST to those undergoing surgery alone using Kaplan-Meier and Cox regression methods. Results A total of 2619 patients were identified. Among these, 12% received NEO, 43% received ADJ, and 45% surgery alone. Age younger than 65 years (adjusted odds ratio [aOR] = 1.53, 95% confidence interval; [CI]: 1.10-2.11), Asian ethnicity (aOR = 2.68, 95% CI: 1.37-5.23), treatment at a high-volume center (aOR = 1.39, 95% CI: 1.06-1.81), and private insurance (aOR = 1.42, 95% CI: 1.05-1.94) were associated with NEO, whereas age younger than 65 years (aOR = 1.95, 95% CI: 1.61-2.38), comorbidity index less than or equal to 1 (aOR = 1.66, 95% CI: 1.29-2.16), and private insurance (aOR = 1.47, 95% CI: 1.20-1.80) were associated with any ST. In the matched cohort, ST was associated with better survival than surgery (adjusted hazard ratio = 0.67, 95% CI: 0.58-0.78). Conclusions A high proportion of patients who undergo pneumonectomy do not receive ST. Patient and socioeconomic factors are associated with the receipt of ST. Given its survival benefit, emphasis should be placed on multimodal treatment strategies, perhaps with greater consideration given to neoadjuvant approaches.
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Affiliation(s)
| | - Mohamed K. Kamel
- Department of Cardiothoracic Surgery, University of Rochester Medical Center, Rochester, New York
| | - Gbalekan Dawodu
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Mostafa Elbahrawy
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Marc Vimolratana
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Neel P. Chudgar
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Brendon M. Stiles
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
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Zeng L, Zhou Y, Zhang X, Xu Q, Zhou C, Zeng F, Jiang W, Wang Z, Deng L, Yang H, Liu L, Xiong Y, Zhang B, Yang N, Zhang Y. Copy number variations mediate major pathological response to induction chemo-immunotherapy in unresectable stage IIIA-IIIB lung cancer. Lung Cancer 2023; 178:134-142. [PMID: 36858002 DOI: 10.1016/j.lungcan.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/05/2023] [Accepted: 02/21/2023] [Indexed: 03/02/2023]
Abstract
INTRODUCTION Non-small cell lung cancer (NSCLC) is the most common type of lung cancer. Despite this, evidence supporting optimal management of certain stages remains a topic of debate. In this retrospective study we examine the efficacy and safety, as well as exploring the biomarkers of neoadjuvant induction immuno-chemotherapy, in Chinese patients with unresectable stage III NSCLC. METHODS Patients with unresectable stage III NSCLC who were identified as driver mutation-negative and who received neoadjuvant chemo-immunotherapy were enrolled from three Chinese hospitals between Jan. 17, 2019, and Jan.17, 2022. Perioperative outcomes and survival data were collected. Retrospective biomarker exploration was performed in available baseline tumor samples and surgical specimens. RESULTS 94 patients were enrolled and received chemo-immunotherapy as neoadjuvant treatment. 80 patients had squamous cell carcinoma, and 26 had stage IIIB disease. Surgery conversion rate was 74.4%, R0 resection rate was 98.4%. Of 64 patients who underwent surgery, major pathological response (MPR) rate was 65.6% and pathologic complete response (pCR) rate was 42.2%. 73% of patients with N2 disease demonstrated down-staging to N0. Treatment-related adverse events (TRAEs) occurred in 43 patients (45.7%) with anemia was the most common. The Grade ≥ 3 TRAEs rate was 3.2% (3/94). A significant association between copy number variation (CNV) ploidy was also found. CONCLUSION The combination treatment of immuno-chemotherapy for unresectable stage III NSCLC is not only effective but also has a favourable safety profile. For the first time we provide evidence that CNV status may be a predictive biomarker of MPR.
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Affiliation(s)
- Liang Zeng
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, China
| | - Yuling Zhou
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, China; Graduate Collaborative Training Base of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
| | - Xiangyu Zhang
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, China
| | - Qinqin Xu
- Department of Medical Oncology, Qinghai Provincial People's Hospital, Xining 810000, China
| | - Chunhua Zhou
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, China
| | - Fanxu Zeng
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, China
| | - Wenjuan Jiang
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, China
| | - Zhan Wang
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, China
| | - Li Deng
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, China
| | - Haiyan Yang
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, China; Graduate Collaborative Training Base of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
| | - Li Liu
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, China; Graduate Collaborative Training Base of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
| | - Yi Xiong
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, China; Graduate Collaborative Training Base of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
| | - Baihua Zhang
- Department of Thoracic Surgery, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, Hunan 410008, China
| | - Nong Yang
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, China; Graduate Collaborative Training Base of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
| | - Yongchang Zhang
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, China; Graduate Collaborative Training Base of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China.
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Yuan H, Tan X, Sun X, He L, Li D, Jiang L. Role of 18F-FDG PET/CT and sarcopenia in untreated non-small cell lung cancer with advanced stage. Jpn J Radiol 2022; 41:521-530. [PMID: 36480105 DOI: 10.1007/s11604-022-01369-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Sarcopenia is essential in managing advanced stage (III-IV) non-small cell lung cancer (NSCLC) but is laborious to diagnose using currently available method. This study aimed to establish a simple approach to predict sarcopenia using 18F-FDG PET/CT parameters and clinical characteristics and determine their roles in prognostication in advanced stage NSCLC. METHODS Untreated 202 NSCLC patients with stage III-IV were retrospectively reviewed. Sarcopenia was defined using the skeletal muscle index (SMI) measured at the third lumbar vertebra (L3). 18F-FDG PET/CT metabolic parameters of maximum standard uptake value, metabolic tumor volume, and total lesion glycolysis of the primary tumor (SUVmax_T, MTV_T, and TLG_T) and of whole-body lesions (MTV_WB and TLG_WB) were measured. Besides, SUVmax of the psoas major muscle (SUVmax_Muscle) was measured at the L3 level. The diagnostic endpoint was the probability of sarcopenia, and the survival endpoints included progression-free survival (PFS) and overall survival (OS). RESULTS Among the enrolled 202 patients, 82 (40.6%) were diagnosed with sarcopenia. Higher age, male, lower BMI, and lower SUVmax_Muscle were correlated with a higher incidence of sarcopenia (P < 0.05), while age, sex, BMI, and SUVmax_Muscle were independently predictive of sarcopenia, and thus were utilized to construct a nomogram model. Multivariate Cox regression analysis revealed that sarcopenia score derived from the nomogram model, sarcopenia, stage, and TLG_WB were independently predictive of both PFS and OS. CONCLUSION The incidence of sarcopenia increased with declining SUVmax_Muscle in advanced stage NSCLC. Our model using age, sex, BMI, and SUVmax_Muscle might be substituted for the complicated measurement of SMI. After adjustment by stage and TLG_WB, both sarcopenia score and sarcopenia were found to be independently predictive of PFS and OS.
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Chiappetta M, Tabacco D, Iaffaldano AG, Evangelista J, Congedo MT, Sassorossi C, Meacci E, D’Argento E, Bria E, Vita E, Tortora G, Boldrini L, Charles-Davies D, Massaccesi M, Martino A, Mazzarella C, Valentini V, Margaritora S, Lococo F. Clinical Stage III NSCLC Patients Treated with Neoadjuvant Therapy and Surgery: The Prognostic Role of Nodal Characteristics. Life (Basel) 2022; 12:life12111753. [PMID: 36362907 PMCID: PMC9692699 DOI: 10.3390/life12111753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 10/25/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND: The aim of this study is to analyze the prognostic factors in patients that underwent induction therapy and surgery for clinical stage III NSCLC. METHODS: Clinical and pathological characteristics of stage III NSCLC patients for N2 involvement that underwent neoadjuvant treatment (NAD) and surgery from 1/01/1998 to 31/12/2017 were collected and retrospectively analyzed. Tumor characteristics, yClinical, yPathological stage and lymph node characteristics were correlated to Overall Survival (OS). RESULTS: The analysis was conducted on 180 patients. Five-year OS (5YOS) was 50.9%. Univariable analysis results revealed old age (p = 0.003), clinical N2 post-NAD (p = 0.01), pneumonectomy (0.005), persistent pathological N2 (p = 0.039, HR 1.9, 95% CI 1.09−2.68) and adjuvant therapy absence (p = 0.049) as significant negative prognostic factors. Multivariable analysis confirmed pN0N1 (p = 0.02, HR 0.29, 95% CI 0.13−0.62) as a favorable independent prognostic factor and adjuvant therapy absence (p = 0.012, HR 2.61, 95% CI 1.23−5.50) as a negative prognostic factor. Patients with persistent N2 presented a 5YOS of 35.3% vs. 55.8% in pN0N1 patients. Regarding lymph node parameters, the lymph node ratio (NR) significantly correlated with OS: 5YOS of 67.6% in patients with NR < 50% vs. 29.5% in NR > 50% (p = 0.029). CONCLUSION: Clinical response aided the stratification of prognosis in patients that underwent multimodal treatment for stage III NSCLC. Adjuvant therapy seemed to be an important option in these patients, while node ratio was a strong prognosticator in patients with persistent nodal involvement.
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Affiliation(s)
- Marco Chiappetta
- Università Cattolica del Sacro Cuore, 00135 Rome, Italy
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, LARGO A. Gemelli 8, 00135 Rome, Italy
| | - Diomira Tabacco
- Università Cattolica del Sacro Cuore, 00135 Rome, Italy
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, LARGO A. Gemelli 8, 00135 Rome, Italy
| | - Amedeo Giuseppe Iaffaldano
- Università Cattolica del Sacro Cuore, 00135 Rome, Italy
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, LARGO A. Gemelli 8, 00135 Rome, Italy
| | - Jessica Evangelista
- Università Cattolica del Sacro Cuore, 00135 Rome, Italy
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, LARGO A. Gemelli 8, 00135 Rome, Italy
| | - Maria Teresa Congedo
- Università Cattolica del Sacro Cuore, 00135 Rome, Italy
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, LARGO A. Gemelli 8, 00135 Rome, Italy
- Correspondence: ; Tel.: +39-3471591586 or +39-06356353
| | - Carolina Sassorossi
- Università Cattolica del Sacro Cuore, 00135 Rome, Italy
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, LARGO A. Gemelli 8, 00135 Rome, Italy
| | - Elisa Meacci
- Università Cattolica del Sacro Cuore, 00135 Rome, Italy
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, LARGO A. Gemelli 8, 00135 Rome, Italy
| | - Ettore D’Argento
- Università Cattolica del Sacro Cuore, 00135 Rome, Italy
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, LARGO A. Gemelli 8, 00135 Rome, Italy
| | - Emilio Bria
- Università Cattolica del Sacro Cuore, 00135 Rome, Italy
- Medical Oncology, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Emanuele Vita
- Università Cattolica del Sacro Cuore, 00135 Rome, Italy
- Medical Oncology, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giampaolo Tortora
- Università Cattolica del Sacro Cuore, 00135 Rome, Italy
- Medical Oncology, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Luca Boldrini
- Università Cattolica del Sacro Cuore, 00135 Rome, Italy
- Radiotherapy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, LARGO A. Gemelli 8, 00135 Rome, Italy
| | - Diepriye Charles-Davies
- Università Cattolica del Sacro Cuore, 00135 Rome, Italy
- Radiotherapy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, LARGO A. Gemelli 8, 00135 Rome, Italy
| | - Mariangela Massaccesi
- Università Cattolica del Sacro Cuore, 00135 Rome, Italy
- Radiotherapy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, LARGO A. Gemelli 8, 00135 Rome, Italy
| | - Antonella Martino
- Università Cattolica del Sacro Cuore, 00135 Rome, Italy
- Radiotherapy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, LARGO A. Gemelli 8, 00135 Rome, Italy
| | - Ciro Mazzarella
- Università Cattolica del Sacro Cuore, 00135 Rome, Italy
- Radiotherapy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, LARGO A. Gemelli 8, 00135 Rome, Italy
| | - Vincenzo Valentini
- Università Cattolica del Sacro Cuore, 00135 Rome, Italy
- Radiotherapy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, LARGO A. Gemelli 8, 00135 Rome, Italy
| | - Stefano Margaritora
- Università Cattolica del Sacro Cuore, 00135 Rome, Italy
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, LARGO A. Gemelli 8, 00135 Rome, Italy
| | - Filippo Lococo
- Università Cattolica del Sacro Cuore, 00135 Rome, Italy
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, LARGO A. Gemelli 8, 00135 Rome, Italy
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Lee JM, Kim AW, Marjanski T, Falcoz PE, Tsuboi M, Wu YL, Sun SW, Gitlitz BJ. Important Surgical and Clinical End Points in Neoadjuvant Immunotherapy Trials in Resectable NSCLC. JTO Clin Res Rep 2021; 2:100221. [PMID: 34746882 PMCID: PMC8552106 DOI: 10.1016/j.jtocrr.2021.100221] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/12/2021] [Accepted: 08/14/2021] [Indexed: 12/25/2022] Open
Abstract
Neoadjuvant immunotherapy may improve outcomes in patients with resectable NSCLC and is being evaluated in phase 2 and 3 studies. Nevertheless, preoperative treatment postpones resection; the potential for increased surgical complexity and greater intra- and postoperative morbidity and mortality is an additional consideration. In studies primarily designed to evaluate efficacy, the impact of neoadjuvant immunotherapy on surgery is based on parameters that are poorly defined and reported differently between studies. Defining and reporting common end points among trials would improve understanding and facilitate cross-comparison of different immunotherapy regimens and may facilitate wider adoption of induction therapies by surgeons and oncologists. We propose several surgical end points and related metrics for neoadjuvant immunotherapy in resectable NSCLC. These include the periods from screening to treatment initiation and from last neoadjuvant dose to surgery; reporting of the allowable window for surgery to preclude masking delays caused by induction treatment-related toxicity; complete resection (R0) rate; preoperative downstaging; a standardized list of immune-related adverse events and associated delay to surgery; preoperative attrition; postoperative attrition before adjuvant therapy; and postoperative 30- and 90-day mortality and morbidity rates. Intraoperative end points (blood loss, duration, and type of surgery) and our proposed system of grading complexity based on lymphadenopathy and fibrosis would allow quantitation of technical difficulty and quality of oncologic resection. In conclusion, the standardization, reporting, and prospective inclusion of these end points in study protocols would provide a comparative overview of the impact of different neoadjuvant immunotherapy regimens on surgery and ultimately clinical oncologic outcomes in resectable NSCLC.
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Affiliation(s)
- Jay M Lee
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Anthony W Kim
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Tomasz Marjanski
- Thoracic Surgery Department, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Masahiro Tsuboi
- Division of Thoracic Surgery, Department of Thoracic Surgery & Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangdong, People's Republic of China
| | - Shawn W Sun
- Product Development Clinical Oncology, Genentech, Inc., South San Francisco, California
| | - Barbara J Gitlitz
- Product Development Clinical Oncology, Genentech, Inc., South San Francisco, California
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