Outcomes of surgical resection after neoadjuvant chemoimmunotherapy in locally advanced stage IIIA non-small-cell lung cancer
Por:
Roman, AR, de la Cruz, JLCC, Macia, I, Campuzano, IE, Almanzar, SF, Roel, MD, Munoz, CG, Fontan, EMG, Trueba, IM, Vielva, LR, Garcia, JRC, Tellez, EM, Gonzalez, CP, Lopez, MFJ, Maestre, UJ, Poce, RM, Lorente, DS, Kindelan, AA, Pulla, MP
Publicada:
1 jul 2021
Ahead of Print:
1 mar 2021
Resumen:
OBJECTIVES: This analysis aimed to evaluate perioperative outcomes of surgical resection following neoadjuvant treatment with chemotherapy plus nivolumab in resectable stage IIIA non-small-cell lung cancer.
METHODS: Eligible patients received neoadjuvant chemotherapy (paclitaxel + carboplatin) plus nivolumab for 3 cycles. Reassessment of the tumour was carried out after treatment and patients with at least stable disease as best response underwent pulmonary resection. After surgery, patients received adjuvant treatment with nivolumab for 1year. Surgical data were collected from the NADIM database and patient charts were reviewed for additional surgical details.
RESULTS: Among 46 patients who received neoadjuvant treatment, 41 (89.1%) underwent surgery. Two patients rejected surgery and 3 did not fulfil resectability criteria. There were 35 lobectomies (85.3%), 3 of which were sleeve lobectomies (9.4%), 3 bilobectomies (7.3%) and 3 pneumonectomies (7.3%). Video-assisted thoracoscopy was the initial approach in 51.2% of cases, with a conversion rate of 19% (n=4). There was no operative mortality at either 30 or 90days. The most common complications were prolonged air leak (n=8), pneumonia (n=5) and arrhythmia (n=4). Complete resection (R0) was achieved in all patients who underwent surgery, downstaging was observed in 37 patients (90.2%) and major pathological response in 34 patients (82.9%).
CONCLUSIONS: Surgical resection following induction therapy with chemotherapy plus nivolumab appears to be safe and offers appropriate oncological outcomes. Perioperative morbidity and mortality rates in our study were no higher than previously reported in this setting. A minimally invasive approach is, therefore, feasible.
Filiaciones:
Roman, AR:
Hosp Univ Puerta de Hierro Majadahonda, Dept Thorac Surg, Calle Manuel de Falla S-N, Madrid 28222, Spain
de la Cruz, JLCC:
Hosp Univ Puerta de Hierro Majadahonda, Dept Thorac Surg, Calle Manuel de Falla S-N, Madrid 28222, Spain
Macia, I:
Hosp Univ Puerta de Hierro Majadahonda, Dept Thorac Surg, Calle Manuel de Falla S-N, Madrid 28222, Spain
Campuzano, IE:
Hosp Univ Puerta de Hierro Majadahonda, Dept Thorac Surg, Calle Manuel de Falla S-N, Madrid 28222, Spain
Univ Barcelona, Inst Invest Biomed Bellvitge IDIBELL, Hosp Univ Bellvitge, Dept Thorac Surg, Barcelona, Spain
Univ Barcelona, Unit Human Anat & Embryol, Dept Pathol & Expt Therapeut, Fac Med & Ciencies Salut, Barcelona, Spain
Univ Barcelona, Dept Clin Sci, Fac Med & Ciencies Salut, Barcelona, Spain
Almanzar, SF:
Hosp Clin Univ Valencia, Dept Thorac Surg, Valencia, Spain
Roel, MD:
Complejo Hosp Univ A Coruna, Dept Thorac Surg, La Coruna, Spain
Munoz, CG:
Hosp Gen Univ Alicante, Dept Thorac Surg, Alicante, Spain
Fontan, EMG:
Complejo Univ Vigo, Dept Thorac Surg, Vigo, Spain
Trueba, IM:
Hosp Univ Fdn Jimenez Diaz, Dept Thorac Surg, Madrid, Spain
Vielva, LR:
Hosp Valle De Hebron, Dept Thorac Surg, Barcelona, Spain
Garcia, JRC:
Complejo Hosp Univ Insular Gran Canaria, Dept Thorac Surg, Las Palmas Gran Canaria, Spain
Tellez, EM:
Hosp Univ Santa Creu & St Pau, Dept Thorac Surg, Barcelona, Spain
Gonzalez, CP:
Hosp Univ La Paz, Dept Thorac Surg, Madrid, Spain
Lopez, MFJ:
Hosp Univ Salamanca, Dept Thorac Surg, Salamanca, Spain
Maestre, UJ:
Hosp Univ Cruces, Dept Thorac Surg, Bizkaia, Spain
Poce, RM:
Hosp Reg Univ Malaga, Dept Thorac Surg, Malaga, Spain
Lorente, DS:
Hosp Clin Barcelona, Dept Thorac Surg, Barcelona, Spain
Kindelan, AA:
Hosp Univ Reina Sofia Cordoba, Dept Thorac Surg, Cordoba, Spain
Pulla, MP:
Hosp Univ Puerta de Hierro Majadahonda, Dept Med Oncol, Madrid, Spain
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