Surgical prognosis of navumab or navumab plus epitomumab for the treatment of non-small cell lung cancer

Surgical Outcomes Following Nivolumab or Nivolumab Plus Ipilimumab In Non-Small Cell Lung Cancer

(Nat Rev Cancer;IF:60.716)

• Sepesi B, Zhou N, William Jr. WN, Lin H, Leung CH, Weissferdt A, MitchellKG, Pataer A, Walsh GL, Rice DC, Roth JA, Mehran RJ, Hofstetter WL, Antonoff. MB, Rajaram R,Negrao MV, Tsao AS, Gibbons DL, Lee JJ, Heymach JV, Vaporciyan AA, Swisher SG, CasconeT, Surgical Outcomes Following Nivolumab or Nivolumab Plus Ipilimumab In Non-Small Cell
• LungCancer, The Journal of Thoracic and Cardiovascular Surgery (2022), doi: https://doi.org/10.1016/j.jtcvs.2022.01.019

BACKGROUND background

Surgical outcomes in non-small cell lung cancer following neoadjuvant immune checkpoint inhibitors (ICIs) continue to be debated. We assessed perioperative outcomes of NEOSTAR trial patients after immunotherapy.

The surgical outcomes of neoadjuvant immune checkpoint inhibitors (ICIs) for the treatment of non-small cell lung cancer remain controversial. We evaluated perioperative outcomes in patients in the NEOSTAR trial after immunotherapy.

METHODS method

Forty-four patients with stage I-IIIA NSCLC (AJCC 7 th ) were randomized to nivolumab (N, 3 mg/kg IV, days 1, 15, 29; n=23) or nivolumab plus ipilimumab (NI, 1 mg/kg IV, day 1; n=21). Curative-intent operations were planned between 3-6 weeks after the last dose of neoadjuvant N. Patients who completed resection upfront or following chemotherapy from the same time period were used as comparison.

44 patients with stage I-IIIA NSCLC (AJCC 7th edition) were randomized to receive nalvulamab (N, 3 mg/kg IV, days 1, 15, 29; n=23) or nvulamumab + ipilimumab (NI, 1 mg/kg IV, day 1; n = 21)。 Radical surgery is planned within 3-6 weeks after the last neoadjuvant treatment. Compare patients who completed resection before or after chemotherapy at the same period.

RESULTS results

In the N-arm, 21 (91%) were resected on-trial, one underwent surgery off-trial, and one was not resected (toxicity-related). In the NI-arm, 16 (76%) resections were on-trial, one off trial, and four not resected (none toxicity-related). Median time to operation was 31 days, and consisted of 2 (5%) pneumonectomies, 33 (89%) lobectomies, and 1 (3%) each of segmentectomy and wedge resection. Approach was 27 (73%) thoracotomy, 7 (19%) thoracoscopy, and 3 (8%) robotic-assisted. Conversion occurred in 17% (n=2/12) of minimally-invasive cases. All 37 achieved R0 resections. Pulmonary, cardiac, enteric, neurologic, and wound complications occurred in 9 (24%), 4 (11%), 2 (5%), 1 (3%), and 1 (3%) patient, respectively. The 30- and 90-day mortality rate was 0 and 2.7% (n=1), respectively. Postoperative complications rates were comparable to lung resection upfront or following chemotherapy.

In group N, 21 patients (91%) were excised in the trial, 1 was surgically performed outside the trial, and 1 was unrecovered (toxicity-related). In the NI group, 16 (76%) resections were performed in trials, 1 was non-trial, and 4 were unresected (non-toxicity-related). The median duration of surgery was 31 days, including total pneumonectomy in 2 cases (5%), lobectomy in 33 cases (89%), and pulmonary segment resection and wedge resection in 1 case (3%) respectively. The approach was 27 (73%) open chest, 7 (19%) thoracoscopic, and 3 (8%) robotically assisted. Transit occurs in 17% (n=2/12) of minimally invasive cases. All 37 cases achieved R0 excision. Complications of lung, heart, intestine, nervous system, and wound were 9 (24%), 4 (11%), 2 (5%), 1 (3%) and 1 (3%), respectively. The mortality rates at 30 and 90 days were 0 and 2.7% (n=1), respectively. The incidence of postoperative complications is comparable to that of pneumonectomy before or after chemotherapy.

CONCLUSIONS Conclusion

Operating following neoadjuvant N or NI is safe and effective and yields perioperative outcomes similar to those achieved after chemotherapy or upfront resection.

Surgery after neoadjuvant N or NI surgery is safe and effective, with perioperative effects similar to post-chemotherapy or pre-resection.