Wait-and-See Treatment Strategy Could be Considered for Lung Adenocarcinoma with Special Pleural Dissemination Lesions, and Low Genomic Instability Correlates with Better Survival

• Published in: Annals of surgical oncology Vol. 27; no. 10; pp. 3808 - 3818
• Main Authors: Chen, Ying, Tang, Wen-Fang, Lin, Huan, Bao, Hua, Li, Wei, Wang, Ao, Wu, Xue, Su, Jian, Lin, Jie-Shan, Shao, Yang W., Yang, Xue-Ning, Wu, Yi-Long, Zhong, Wen-Zhao
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.10.2020; Springer Nature B.V
• Subjects: Adenocarcinoma; Adenocarcinoma of Lung; Antineoplastic Agents - therapeutic use; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - therapy; Chemotherapy; Chromosome 18; Disease-Free Survival; Epidermal growth factor; Epidermal growth factor receptors; ErbB Receptors - genetics; Genomic Instability; Humans; Lung cancer; Lung Neoplasms - drug therapy; Lung Neoplasms - therapy; Lymph nodes; Medicine; Medicine & Public Health; Metastases; Metastasis; Mutation; Non-small cell lung carcinoma; Oncology; Protein Kinase Inhibitors - therapeutic use; Retrospective Studies; Small cell lung carcinoma; Surgery; Surgical Oncology; Thoracic Oncology; Tumors
• ISSN: 1068-9265; 1534-4681; 1534-4681
• DOI: 10.1245/s10434-020-08400-1

Background This study aimed to evaluate the feasibility of a wait-and-see strategy for non-small cell lung cancer (NSCLC) patients with special pleural dissemination lesions (r-pM1a and s-pM1a). Furthermore, the study characterized genomic alternations about disease progression. Methods For this study, 131 NSCLC patients with a diagnosis of pM1a were retrospectively selected. Survival differences were evaluated among patients treated with three different initial postoperative treatments: chemotherapy, targeted therapy, and wait-and-see strategy. Whole-exome sequencing (WES) was performed on primary and metastatic tumors of 10 patients with dramatic progression and 13 patients with gradual progression. Results The wait-and-see group showed better progression-free survival (PFS) than the chemotherapy group ( p  < 0.001) but PFS similar to that of targeted group ( p  = 0.984). This pattern persisted in epidermal growth factor receptor (EGFR)-positive patients. For patients with EGFR-negative/unknown status, PFS was longer in the wait-and-see group than in the two treatment groups. Furthermore, better overall survival (OS) was observed for the patients who received chemotherapy or targeted therapy after the wait-and-see strategy than for those who received chemotherapy or targeted therapy immediately. Lymph node status was an independent prognostic factor for PFS and OS. Finally, WES analysis showed that a high genomic instability index (GIS) and chromosome 18q loss were more common in metastatic tumors, and low GIS was significantly associated with better PFS ( p  = 0.016). Conclusions The wait-and-see strategy could be considered for special pM1a patients without lymph nodes metastasis, and patients with a low GIS may be suitable for this strategy.