Outcomes of surgical resection after neoadjuvant chemoimmunotherapy in locally advanced stage IIIA non-small-cell lung cancer

• Published in: European journal of cardio-thoracic surgery Vol. 60; no. 1; pp. 81 - 88
• Main Authors: Romero Román, Alejandra, Campo-Cañaveral de la Cruz, Jose Luis, Macía, Iván, Escobar Campuzano, Ignacio, Figueroa Almánzar, Santiago, Delgado Roel, María, Gálvez Muñoz, Carlos, García Fontán, Eva M, Muguruza Trueba, Ignacio, Romero Vielva, Laura, Cano Garcia, José Ramón, Martínez Téllez, Elisabeth, Partida González, Concepción, Jiménez López, Marcelo Fernando, Jiménez Maestre, Unai, Mongil Poce, Roberto, Sánchez Lorente, David, Álvarez Kindelán, Antonio, Provencio Pulla, Mariano
• Format: Journal Article
• Language: English
• Published: Germany Oxford University Press 14.07.2021
• Subjects: Post induction surgery; Chemotherapy; Immunotherapy; Locally advanced non-small-cell lung cancer
• ISSN: 1010-7940; 1873-734X; 1873-734X
• DOI: 10.1093/ejcts/ezab007

Abstract 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 1 year. 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 90 days. 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.